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Wang Z, Dandu C, Guo Y, Gao M, Lan D, Pan L, Zhou D, Ding Y, Ji X, Meng R. A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis. J Headache Pain 2023; 24:29. [PMID: 36932331 PMCID: PMC10022088 DOI: 10.1186/s10194-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. METHODS In this retrospective study from January 2019 through December 2021, we consecutively enrolled patients with a first-time confirmed diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV). In these patients, a comprehensive CVST-Score was established using magnetic resonance black-blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess the potential of using the CVST-score to evaluate ICP noninvasively and dynamically. RESULTS A total of 87 patients were included in the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP<250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP>330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, the CVST-Score was linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and >330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). CONCLUSIONS A simple and noninvasive CVST-Score can rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. The CVST-Score can aid in evaluating therapeutic responses and avoiding unnecessary invasive procedures at long-term follow-up.
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Affiliation(s)
- Zhongao Wang
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Chaitu Dandu
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Yibing Guo
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Meini Gao
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Duo Lan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Liqun Pan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Da Zhou
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yuchuan Ding
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Xunming Ji
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Ran Meng
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
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3
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Yaghi S, Shu L, Bakradze E, Salehi Omran S, Giles JA, Amar JY, Henninger N, Elnazeir M, Liberman AL, Moncrieffe K, Lu J, Sharma R, Cheng Y, Zubair AS, Simpkins AN, Li GT, Kung JC, Perez D, Heldner M, Scutelnic A, Seiffge D, Siepen B, Rothstein A, Khazaal O, Do D, Kasab SA, Rahman LA, Mistry EA, Kerrigan D, Lafever H, Nguyen TN, Klein P, Aparicio H, Frontera J, Kuohn L, Agarwal S, Stretz C, Kala N, El Jamal S, Chang A, Cutting S, Xiao H, de Havenon A, Muddasani V, Wu T, Wilson D, Nouh A, Asad SD, Qureshi A, Moore J, Khatri P, Aziz Y, Casteigne B, Khan M, Cheng Y, Mac Grory B, Weiss M, Ryan D, Vedovati MC, Paciaroni M, Siegler JE, Kamen S, Yu S, Leon Guerrero CR, Atallah E, De Marchis GM, Brehm A, Dittrich T, Psychogios M, Alvarado-Dyer R, Kass-Hout T, Prabhakaran S, Honda T, Liebeskind DS, Furie K. Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study. Stroke 2022; 53:728-738. [PMID: 35143325 DOI: 10.1161/strokeaha.121.037541] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. METHODS This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups. RESULTS Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140-720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 [95% CI, 0.51-1.73]; P=0.84), death (aHR, 0.78 [95% CI, 0.22-2.76]; P=0.70), and rate of partial/complete recanalization (aOR, 0.92 [95% CI, 0.48-1.73]; P=0.79), but a lower risk of major hemorrhage (aHR, 0.35 [95% CI, 0.15-0.82]; P=0.02). CONCLUSIONS In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | | | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.)
| | - James A Giles
- Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)
| | - Jordan Y Amar
- Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester. (N.H., M.E.).,Department of Psychiatry, University of Massachusetts, Worcester. (N.H.)
| | - Marwa Elnazeir
- Department of Neurology, University of Massachusetts, Worcester. (N.H., M.E.)
| | - Ava L Liberman
- Department of Neurology, Weill Cornell Medical Center, NY (A.L.L.)
| | | | - Jenny Lu
- Department of Neurology, Montefiore Medical Center, NY (K.M., J.L.)
| | - Richa Sharma
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Yee Cheng
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Adeel S Zubair
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Alexis N Simpkins
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Grace T Li
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Justin Chi Kung
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Dezaray Perez
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Mirjam Heldner
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - David Seiffge
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Bernhard Siepen
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - Ossama Khazaal
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - David Do
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston (S.A.K., L.A.R.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (S.A.K.)
| | - Line Abdul Rahman
- Department of Neurology, Medical University of South Carolina, Charleston (S.A.K., L.A.R.)
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Deborah Kerrigan
- Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)
| | - Hayden Lafever
- Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | - Piers Klein
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.).,Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | - Hugo Aparicio
- Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | | | - Lindsey Kuohn
- Department of Neurology, New York University, NY (J.F., L.K., S.A.)
| | - Shashank Agarwal
- Department of Neurology, New York University, NY (J.F., L.K., S.A.)
| | - Christoph Stretz
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Narendra Kala
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Sleiman El Jamal
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Alison Chang
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Shawna Cutting
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Han Xiao
- Department of Biostatistics, University of California Santa Barbara (H.X.)
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Varsha Muddasani
- Department of Neurology, University of Utah, Salt Lake City (V.M.)
| | - Teddy Wu
- Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)
| | - Duncan Wilson
- Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, CT (A.N., S.D.A.)
| | | | - Abid Qureshi
- Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)
| | - Justin Moore
- Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)
| | | | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Bryce Casteigne
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Muhib Khan
- Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)
| | - Yao Cheng
- Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | - Martin Weiss
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | - Dylan Ryan
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | | | | | - James E Siegler
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | - Scott Kamen
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | - Siyuan Yu
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | | | - Eugenie Atallah
- Department of Neurology, George Washington University, District of Columbia (C.R.L.G., E.A.)
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)
| | - Alex Brehm
- Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)
| | - Tolga Dittrich
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)
| | - Marios Psychogios
- Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)
| | | | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)
| | - Tristan Honda
- Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)
| | - David S Liebeskind
- Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)
| | - Karen Furie
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
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