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. 2024 Mar;57(3):402-407.
doi: 10.1007/s11239-023-02935-2. Epub 2023 Dec 25.

Elevated factor XI is associated with increased risk of recurrent cerebral venous sinus thrombosis: a cohort study

Elżbieta Paszek  1   2 , Maciej Polak  3 , Anetta Undas  4   5
Affiliations

Elevated factor XI is associated with increased risk of recurrent cerebral venous sinus thrombosis: a cohort study

Elżbieta Paszek et al. J Thromb Thrombolysis. 2024 Mar.

Abstract

Cerebral venous sinus thrombosis (CVST) has no identified cause in 15% of cases. Elevated factors (F) VIII and FXI have been associated with thromboembolism, but data on CVST are limited. We hypothesized that elevated plasma FVIII and FXI predispose to first and recurrent CVST. In 50 CVST survivors aged < 60 years, following anticoagulant cessation and in 50 controls, we determined plasma FVIII and FXI, along with fibrin clot properties: lysis time, permeability, maximum D-dimer (D-Dmax), and maximum rate of D-dimer increase (D-Drate). We recorded CVST recurrence during a follow-up of 58.5 (55.0-60.0) months. Plasma FVIII was 22.7% higher in CVST than in controls, with elevated FVIII > 150% in 13 (26%) vs. 4 (8%) patients, respectively (p = 0.02). Median FXI tended to be higher in CVST vs. controls (110.5 [99.0-117-0]% vs. 104.5 [97.0-116.0]%, p = 0.07), while FXI > 120% was observed more commonly in the former group (12 [24%] vs. 4 [8%], respectively, p = 0.03). Patients with FVIII > 150% were less likely to achieve complete recanalization compared with the remainder (2 [15.4%] vs. 28 [75.7%], respectively; p < 0.001). Eight patients (16%) experienced CVST recurrence. They had higher baseline FXI, but not FVIII, as compared with the remainder (125.5 [114.5-140.0]% vs. 107.5 [102.0-117.0]%, respectively, p = 0.01). Patients with FXI > 120% were four times more likely to have recurrent CVST (5 [62.5%] vs. 7 [16.7%], respectively; p = 0.01). Plasma FXI > 120% could represent a novel risk factor for first and recurrent CVST. Given advances in anti-FXI agents, CVST might be another indication for this emerging treatment.

Keywords: Cerebral venous sinus thrombosis; Factor VIII; Factor XI; Stroke; Thrombosis.

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Conflict of interest statement

The authors have no conflict of interest to report with regard to this study.

Figures

Fig. 1
Fig. 1
Factor (F)VIII and XI levels with regard to the index cerebral venous sinus thrombosis (CVST) and recurrence. A – Factor VIII and CVST; B – Factor XI and CVST; C – Factor VIII and recurrent CVST; D – Factor XI and recurrent CVST
See this image and copyright information in PMC

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