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. 2024 Feb 4;7(2):e1869.
doi: 10.1002/hsr2.1869. eCollection 2024 Feb.

Direct oral anticoagulants compared to warfarin in long-term management of cerebral venous thrombosis: A comprehensive meta-analysis

Redoy Ranjan  1   2 , Gie Ken-Dror  2 , Pankaj Sharma  2   3
Affiliations

Direct oral anticoagulants compared to warfarin in long-term management of cerebral venous thrombosis: A comprehensive meta-analysis

Redoy Ranjan et al. Health Sci Rep. .

Abstract

Objectives: We compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long-term (≥6 months) treatment of cerebral venous thrombosis (CVT).

Methods: We searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CVT management. Modified Rankin scores (mRS), new intracranial hemorrhage, all-cause mortality, recurrence and nonrecanalisation events were used to assess outcome. RevMan v5.4 software and the Cochran-Mantel-Haenszel method were utilized to analyse data.

Results: A total of 25 studies involving 2301 patients were identified as having treated CVT with either DOACs or warfarin. Good long-term mRS scores 0-2 (risk ratio [RR] = 1.01, 95% CI = 0.98-1.03; p = 0.61), new intracranial hemorrhage (RR = 1.00, 95% CI = 0.48-2.08; p = 0.99), all-cause mortality (RR = 1.00, 95% CI = 0.50-1.98; p = 0.99), nonrecanalisation (RR = 0.95, 95% CI = 0.77-1.18; p = 0.65) and recurrence venous thrombosis events (RR = 0.63, 95% CI = 0.33-1.22; p = 0.17) were similar between the two treatment arms. Subgroup analysis found recurrence of venous thrombosis was lower in the rivaroxaban group compared to warfarin (2.2% vs. 8.5%, RR = 0.33, 95% CI = 0.11-0.98; p = 0.05).

Conclusion: DOACs and warfarin provide comparable long-term safety and efficacy profiles. DOACs may be preferred over warfarin due to their ease of clinical management.

Keywords: apixaban; cerebral venous thrombosis; dabigatran; direct oral anticoagulants; edoxaban; efficacy; rivaroxaban; safety; warfarin.

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Conflict of interest statement

Redoy Ranjan is an Editorial Board member of Health Science Reports but was excluded from all editorial decision‐making related to the acceptance of this article for publication. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram according to PRISMA 2020 guidelines illustrates difference phases of systemic review.
Figure 2
Figure 2
Good clinical outcome based on mRS 0–2 score between DOACs and warfarin therapy arms.
Figure 3
Figure 3
The occurrence of new intracranial hemorrhage (ICH) between DOACs and warfarin therapy arms.
Figure 4
Figure 4
The recurrence of venous thrombosis between rivaroxaban and warfarin arms.
Figure 5
Figure 5
Risk of bias graph for RCTs (A) and observational cohort studies (B).
See this image and copyright information in PMC

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