Direct Oral Anticoagulants vs. Vitamin K Antagonists in Cerebral Venous Thrombosis
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on May 30th, 2025
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The optimal anticoagulation strategy for patients with cerebral venous thrombosis remains a topic of ongoing debate. While direct oral anticoagulants are more convenient for patients and have been associated with lower rates of intracranial hemorrhage, vitamin K antagonists remain more cost-effective. Additionally, vitamin K antagonists are associated with lower gastrointestinal bleeding risk, and are preferred in patients with mechanical heart valves. Given the lack of consensus, a multinational observational study was undertaken with support from the Netherlands Thrombosis Foundation.
This prospective study spanned 23 countries and enrolled 619 patients with radiologically confirmed cerebral venous thrombosis. Among them, 65% received direct oral anticoagulants, while 35% were treated with vitamin K antagonists. After six months of follow-up, the study found no significant difference between the two groups in the risk of recurrent venous thromboembolism or major hemorrhage. The researchers emphasized that the rarity of cerebral venous thrombosis poses a major challenge to conducting large-scale randomized controlled trials, and current trials remain limited in size.
This prospective study spanned 23 countries and enrolled 619 patients with radiologically confirmed cerebral venous thrombosis. Among them, 65% received direct oral anticoagulants, while 35% were treated with vitamin K antagonists. After six months of follow-up, the study found no significant difference between the two groups in the risk of recurrent venous thromboembolism or major hemorrhage. The researchers emphasized that the rarity of cerebral venous thrombosis poses a major challenge to conducting large-scale randomized controlled trials, and current trials remain limited in size.