Combination of Steroid and Anticoagulant Therapy to Treat Acute/Subacute Severe Cerebral Venous Thrombosis

Abstract Background: Accumulating evidence suggest that the inflammatory response plays a vital role in regulatingsevere CVT pathogenesis. However, whether CVT patients can benefit from anti-inflammatory therapy has been debated. This study explored the potential efficacy and safety of steroid combined with anticoagulant therapy in acute/subacute severe CVT patients. Methods: We reviewed the data of patients with acute/subacute severe CVT treated with a short-term application of steroid or not from a prospective stroke registry of our center. We compared functional outcomes and major adverse events at 6 months follow-up after discharge using the propensity score matching method(PSM). Results: A total of 248 acute/subacute severe CVT patients were eligible for this study. After PSM, there were 85 patients in the steroid group and 85 in the nonsteroid group. Compared with the nonsteroid group, the steroid group had a higher likelihood ofmRS(0-2)(85.88% versus 75.29%, P=0.03) and a lower likelihood of residual headache(19.28% versus 47.50%, P=0.01) at 6 months follow-up after discharge. Multivariable logistic regression analysis shows steroid treatment(OR 4.69, 95% CI 1.63-13.48, P=0.01) was associated with the favorite outcome in the matched cohort. Regarding steroid safety, the likelihood of CVT recurrence, lower extremity deep venous thrombosis, pulmonary embolism, infection and mortality did not differ significantly(P＞0.05) between the steroid and nonsteroid groups. Conclusion: The findings suggest that short-term use of steroid might be an effective and safe adjuvant therapy for acute/subacute severe CVT under standard anticoagulant treatment. However, the findings need to be further verified using prospective research.