Real-world study on DOACs vs. warfarin in cerebral venous thrombosis

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Created On: 02/05/2025

Cerebral venous thrombosis (CVT), a rare yet challenging stroke subtype, remains cumbersome to manage, especially in younger individuals.

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Key take away

DOACs reduce cerebral venous thrombosis recurrence and intracerebral hemorrhage risk, particularly in females, middle-aged adults, and those with normal weight, while maintaining comparable all-cause mortality.

Background

Cerebral venous thrombosis (CVT), a rare yet challenging stroke subtype, remains cumbersome to manage, especially in younger individuals. Standard treatment involves heparin transitioning to warfarin, though warfarin’s drawbacks necessitate the exploration of alternatives.

Direct oral anticoagulants (DOACs) have emerged as a potential option, but evidence supporting their role in CVT is limited. This study aimed to fill this gap by determining the real-world effectiveness and safety of DOACs in CVT care.

Method

Leveraging TriNetX data, a retrospective cohort analysis was carried out to identify CVT cases. Propensity score matching (PSM) ensured balanced baseline characteristics between DOAC and warfarin recipients. The key endpoint was CVT recurrence, with secondary measures assessing all-cause mortality and intracerebral hemorrhage incidence.

Result

Among 1,507 patients, PSM produced 551 well-matched pairs. The DOAC cohort exhibited a lower recurrence risk (hazard ratio [HR] 0.77) and superior 360-day event-free survival. Subgroup analysis revealed a pronounced recurrence reduction in females (HR 0.67), individuals aged 41–64 (HR 0.52), and those with normal weight (HR 0.65). DOAC users also had a decreased risk of intracerebral hemorrhage (HR 0.62) while maintaining mortality rates similar to warfarin (HR, 1.03).

Conclusion

These real-world findings position DOACs as a compelling alternative for CVT management, offering a lower recurrence risk and reduced intracerebral hemorrhage incidence while preserving overall survival rates comparable to warfarin.