From the Research
The rate of venous thromboembolism (VTE) recurrence after central venous sinus thrombosis (CVST) is approximately 2-7% per year, with the most recent and highest quality study suggesting a recurrence rate of 2.03 per 100 person-years for all manifestations of venous thromboembolism and 0.53 per 100 person-years for CSVT specifically 1.
Key Points
- Patients who experience CVST have a higher risk of recurrent thrombotic events, both in cerebral veins and in other venous territories.
- Risk factors for recurrence include male sex, thrombophilia (particularly antiphospholipid syndrome, protein C or S deficiency, antithrombin deficiency, or homozygous factor V Leiden mutation), history of previous VTE, and unprovoked CVST.
- Anticoagulation therapy is typically recommended for 3-12 months after CVST with either warfarin (target INR 2-3) or direct oral anticoagulants (DOACs) such as rivaroxaban (15-20 mg daily), apixaban (5 mg twice daily), or dabigatran (150 mg twice daily) 2, 3.
- For patients with high-risk thrombophilia or recurrent events, indefinite anticoagulation may be necessary.
- The recurrence risk is highest in the first year after the initial event and decreases over time.
- Regular follow-up with neuroimaging (MRI/MRV) at 3-6 months after diagnosis is recommended to assess recanalization, which can help guide anticoagulation duration decisions.
Recurrence Rate
The recurrence rate of VTE after CVST is a significant concern, with studies suggesting that the rate of recurrence is highest in the first year after the initial event and decreases over time 1. The most recent and highest quality study suggests a recurrence rate of 2.03 per 100 person-years for all manifestations of venous thromboembolism and 0.53 per 100 person-years for CSVT specifically 1.
Anticoagulation Therapy
Anticoagulation therapy is a crucial aspect of managing CVST, with the goal of preventing recurrent thrombotic events. The choice of anticoagulant depends on various factors, including the patient's risk of recurrence, bleeding risk, and personal preferences. Direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, and dabigatran have been shown to be effective and safe in the treatment of CVST, with some studies suggesting that they may be superior to warfarin in terms of efficacy and safety 2, 3.