Novel Oral Anticoagulants (NOACs) vs. Warfarin in the Treatment of Cerebral venous Sinus Thrombosis (CVST): A retrospective study of functional and radiographic outcomes among patients enrolled in BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) at UVA

Objective: To assess 6-month outcomes among patients with CVST treated with NOACs, as compared to warfarin. Background: CVST is a rare form of stroke historically treated with warfarin. Since the introduction of NOACs, practice has shifted, favoring their use in the treatment of CVST. There is limited data substantiating the effect and safety of NOACs for this condition. Design/Methods: Forty patients with diagnosis of CVST, 18+ years of age, and willing to provide a biospecimen to a central DNA repository have enrolled in BEAST at UVA since 2012. Patients completing 6 months of clinical and radiographic follow-up, who were treated with NOACs or warfarin upon discharge were included. We grouped patients by treatment and compared rates of favorable functional outcome (mRS=0–1), radiographic recanalization, recurrent thrombosis, and hemorrhagic complications between groups. Results: Twenty-nine patients were included (apixaban=8, rivaroxaban=2, warfarin=19) in the analysis. Overall, 75.9% of patients (n=22/29) had favorable functional outcomes at six months. All patients in the NOAC group (n=10) and 89.5% (n=17/19) in the warfarin group had at least partial recanalization by six months. In the NOAC group, one patient developed a contralateral CVST; no hemorrhagic events occurred within the 6 months of follow up. In the warfarin group, two patients experienced new thrombotic events (CVST = 1, DVT = 1), and three patients experienced major hemorrhage (subdural hematoma =2, menometrorrhagia = 1) during the follow-up period. There were no statistically significant differences in rates of favorable functional outcome, recanalization, recurrent thrombosis or major hemorrhage between groups. Conclusions: Patients treated with NOACs for CVST achieve similar rates of good functional outcome and recanalization as those treated with warfarin. While not statistically significant, higher rates of major hemorrhage in the warfarin group suggest a favorable safety profile of NOACs. Further study to establish the optimal medical management of CVST is warranted. Disclosure: Dr. Wells has nothing to disclose. Dr. Ehrlich has nothing to disclose. Dr. Johansen has nothing to disclose. Dr. Rahman has nothing to disclose. Dr. Chapman has nothing to disclose. Dr. Worrall has received personal compensation in an editorial capacity for American Academy of Neurology. Dr. Chiota-McCollum has nothing to disclose.