Age of onset of cerebral venous thrombosis: the BEAST study

Redoy Ranjan¹, Gie Ken-Dror¹, Ida Martinelli², Elvira Grandone^{3

4}, Sini Hiltunen⁵, Erik Lindgren^{6

7}, Maurizio Margaglione⁸, Veronique Le Cam Duchez⁹, Aude Bagan Triquenot¹⁰, Marialuisa Zedde¹¹, Michelangelo Mancuso¹², Ynte M Ruigrok¹³, Brad Worrall¹⁴, Jennifer J Majersik¹⁵, Jukka Putaala⁵, Elena Haapaniemi⁵, Susanna M Zuurbier¹⁶, Matthijs C Brouwer¹⁶, Serena M Passamonti², Maria Abbattista², Paolo Bucciarelli², Robin Lemmens^{17

18}, Emanuela Pappalardo¹⁹, Paolo Costa²⁰, Marina Colombi²¹, Diana Aguiar de Sousa^{22

23}, Sofia Rodrigues²⁴, Patrícia Canhao²⁴, Aleksander Tkach¹⁵, Rosa Santacroce⁸, Giovanni Favuzzi³, Antonio Arauz²⁵, Donatella Colaizzo³, Kostas Spengos²⁶, Amanda Hodge²⁷, Reina Ditta²⁷, Thang S Han^{1

28}, Alessandro Pezzini²⁰, Jonathan M Coutinho¹⁶, Vincent Thijs²⁹, Katarina Jood^{6

7}, Turgut Tatlisumak^{5

6

7}, José M Ferro³⁰, Pankaj Sharma^{1

31}

Affiliations

¹ Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK.
² Fondazione IRCCS Ca'Granda - Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
³ Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Home for the Relief of Suffering, S. Giovanni Rotondo, Foggia, Italy.
⁴ Medical and Surgical Department, University of Foggia, Foggia, Italy.
⁵ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁶ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
⁹ Normandy University, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit and INSERM CIC-CRB 1404, Rouen, France.
¹⁰ Department of Neurology, Rouen University Hospital, Rouen, France.
¹¹ Neurology Unit, Stroke Unit, Local Health Unit - Authority IRCCS of Reggio Emilia, Reggio Emilia, Italy.
¹² Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy.
¹³ UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁴ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
¹⁵ Department of Neurology, University of Utah, Salt Lake City, UT, USA.
¹⁶ Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium.
¹⁸ VIB Center for Brain & Disease Research, Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
¹⁹ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
²⁰ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
²¹ Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy.
²² Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal.
²³ CEEM and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
²⁴ Department of Neurosciences, Hospital of Santa Maria, University of Lisbon, Lisbon, Portugal.
²⁵ Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico.
²⁶ Department of Neurology, University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
²⁷ McMaster University, Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
²⁸ Department of Diabetes and Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK.
²⁹ Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.
³⁰ Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.
³¹ Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK.

PMID: 37021156
PMCID: PMC10069208
DOI: 10.1177/23969873221148267

Observational Study

Age of onset of cerebral venous thrombosis: the BEAST study

Redoy Ranjan et al. Eur Stroke J. 2023 Mar.

. 2023 Mar;8(1):344-350.

doi: 10.1177/23969873221148267. Epub 2023 Jan 6.

Authors

Affiliations

¹ Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK.
² Fondazione IRCCS Ca'Granda - Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
³ Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Home for the Relief of Suffering, S. Giovanni Rotondo, Foggia, Italy.
⁴ Medical and Surgical Department, University of Foggia, Foggia, Italy.
⁵ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁶ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
⁹ Normandy University, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit and INSERM CIC-CRB 1404, Rouen, France.
¹⁰ Department of Neurology, Rouen University Hospital, Rouen, France.
¹¹ Neurology Unit, Stroke Unit, Local Health Unit - Authority IRCCS of Reggio Emilia, Reggio Emilia, Italy.
¹² Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy.
¹³ UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁴ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
¹⁵ Department of Neurology, University of Utah, Salt Lake City, UT, USA.
¹⁶ Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium.
¹⁸ VIB Center for Brain & Disease Research, Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
¹⁹ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
²⁰ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
²¹ Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy.
²² Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal.
²³ CEEM and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
²⁴ Department of Neurosciences, Hospital of Santa Maria, University of Lisbon, Lisbon, Portugal.
²⁵ Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico.
²⁶ Department of Neurology, University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
²⁷ McMaster University, Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
²⁸ Department of Diabetes and Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK.
²⁹ Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.
³⁰ Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal.
³¹ Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK.

PMID: 37021156
PMCID: PMC10069208
DOI: 10.1177/23969873221148267

Abstract

Background: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in young adults. We aimed to determine the impact of age, gender and risk factors (including sex-specific) on CVT onset.

Methods: We used data from the BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis), a multicentre multinational prospective observational study on CVT. Composite factors analysis (CFA) was performed to determine the impact on the age of CVT onset in males and females.

Results: A total of 1309 CVT patients (75.3% females) aged ⩾18 years were recruited. The overall median (IQR-interquartile range) age for males and females was 46 (35-58) years and 37 (28-47) years (p < 0.001), respectively. However, the presence of antibiotic-requiring sepsis (p = 0.03, 95% CI 27-47 years) among males and gender-specific risk factors like pregnancy (p < 0.001, 95% CI 29-34 years), puerperium (p < 0.001, 95% CI 26-34 years) and oral contraceptive use (p < 0.001, 95% CI 33-36 years) were significantly associated with earlier onset of CVT among females. CFA demonstrated a significantly earlier onset of CVT in females, ~12 years younger, in those with multiple (⩾1) compared to '0' risk factors (p < 0.001, 95% CI 32-35 years).

Conclusions: Women suffer CVT 9 years earlier in comparison to men. Female patients with multiple (⩾1) risk factors suffer CVT ~12 years earlier compared to those with no identifiable risk factors.

Keywords: Cerebral venous thrombosis; age of onset; cerebral venous sinus thrombosis; women.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Box and Whisker plot demonstrating age distribution among the study population; Red line represents the overall median age of CVT onset.

See this image and copyright information in PMC

References

1. Ferro JM, Canhão P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep 2014; 16: 523. - PubMed
1. Saposnik G, Barinagarrementeria F, Brown RD, et al.; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: 1158–1192. - PubMed
1. Coutinho JM, Zuurbier SM, Aramideh M, et al. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke 2012; 43: 3375–3377. - PubMed
1. Idiculla PS, Gurala D, Palanisamy M, et al. Cerebral venous thrombosis: a comprehensive review. Eur Neurol 2020; 83: 369–379. - PubMed
1. Komro J, Findakly D. Cerebral venous sinus thrombosis in adults with prothrombotic conditions: a systematic review and a case from our institution. Cureus 2020; 12: e7654. - PMC - PubMed

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Age of onset of cerebral venous thrombosis: the BEAST study

Affiliations

Age of onset of cerebral venous thrombosis: the BEAST study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical