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Rivaroxaban for the treatment of cerebral venous thrombosis: a single-center experience

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Abstract

The mainstay of cerebral venous thrombosis (CVT) treatment according to current guidelines is parenteral anticoagulation with unfractionated heparin or low-molecular-weight heparin followed by long-term oral anticoagulation with vitamin K antagonists. Direct oral anticoagulants (DOACs), including the factor Xa inhibitor rivaroxaban, are used occasionally off-label for CVT based on individual treatment plans. This publication sought to report our experience with rivaroxaban for the indication of CVT and to review the relevant literature data concerning this topic. We performed a single-center retrospective analysis including patients from our institution with the diagnosis of cerebral venous thrombosis treated with rivaroxaban. Among 12,500 stroke patients over an 11-year period, we identified 87 cases with a diagnosis of CVT (0.7%). As long-term anticoagulation, 80 of these patients were receiving vitamin K antagonists and seven were receiving DOACs, including six receiving rivaroxaban and one receiving apixaban. Of the six patients receiving rivaroxaban, at least 6 months of clinical follow-up data were available for five of them. Excellent clinical outcomes were obtained in four of these five cases (modified Rankin scale score: 0–1 points). No hemorrhagic events, recurrent thrombosis, or other relevant complications were recorded during the follow-up period. Despite our small study sample size, our positive results support that rivaroxaban may be a safe and effective treatment option for patients with CVT. Hopefully, ongoing randomized clinical trials will better clarify the role of rivaroxaban in the treatment of CVT so as to provide a more convenient and safer alternative to vitamin K antagonists in this context.

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Authors and Affiliations

  1. Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania

    Zoltan Bajko, Smaranda Maier, Anca Motataianu, Sebastian Andone & Rodica Balasa

  2. Department of Interventional Radiology, Mures County Clinical Emergency Hospital, Targu-Mures, Romania

    Rares Cristian Filep

  3. Department of Patophysiology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Marinescu Gh 50, 540136, Targu-Mures, Romania

    Adina Stoian

Authors
  1. Zoltan Bajko
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  2. Smaranda Maier
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  3. Anca Motataianu
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  4. Rares Cristian Filep
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  5. Adina Stoian
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  6. Sebastian Andone
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  7. Rodica Balasa
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Correspondence to Adina Stoian.

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This study was approved by the local Ethic Committee.

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Bajko, Z., Maier, S., Motataianu, A. et al. Rivaroxaban for the treatment of cerebral venous thrombosis: a single-center experience. Acta Neurol Belg 122, 105–111 (2022). https://doi.org/10.1007/s13760-021-01651-z

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  • DOI: https://doi.org/10.1007/s13760-021-01651-z

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