Abstract
Objective: Cerebral venous sinus thrombosis (CVT) is usually treated with heparin and warfarin. Newer anticoagulants are now available but the safety and efficacy of newer drugs is not established.
Background: CVT is an uncommon, often under diagnosed and under treated neurological condition. Traditionally patients are treated with intravenous heparin followed by an oral vitamin K antagonist like warfarin. Direct oral anticoagulants (DOACs) are currently available and may offer advantages over warfarin. There is some evidence to demonstrate the effectiveness of both dabigatran and rivaroxaban. No studies have previously described the use of apixaban in CVT.
Design/Methods: Report two cases of CVT treated with apixaban, review of literature on available treatment options; efficacy and safety of novel oral anticoagulants in patients with systemic thrombosis.
Results: Two patients, a 21 year old woman and a 37 year old African American man, presented with features of cerebral venous sinus thrombosis. While the first patient presented with severe unremitting headache with papilledema due to raised intracranial pressure, the second patient presented with seizures and focal weakness due to parenchymal hemorrhage. After confirming the diagnosis of cerebral venous thrombosis, they were acutely treated with heparin, and subsequently discharged on apixaban. During follow up visits, both patients tolerated apixaban well and did not have any bleeding complications. Follow up scans at 6 weeks for both patients showed resolution of thrombosis and complete recanalization.
Conclusions: CVT is a neurological emergency and is often complicated by associated intraparenchymal hemorrhage which increases the risk of anticoagulation. When compared to both older agents like warfarin and newer oral anticoagulants, including dabigatran and rivaroxaban, apixaban has a lower risk of major bleeding and complications. Therefore, apixaban may be a safe and effective option for the treatment of CVT.
Disclosure: Dr. Rao has nothing to disclose. Dr. Suchdev has nothing to disclose. Dr. Hanni has nothing to disclose. Dr. Ibrahim has nothing to disclose. Dr. Parker Jr. has nothing to disclose. Dr. Rajamani has nothing to disclose. Dr. Mohamed has nothing to disclose.
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