Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)

Abhishek Chaturbedi; Jitendra Thakur

doi:doi:10.11648/j.ijn.20200402.14

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Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)

Abhishek Chaturbedi, Jitendra Thakur

Published in International Journal of Neurosurgery (Volume 4, Issue 2)

Received: 20 July 2020 Accepted: 6 August 2020 Published: 13 August 2020

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Abstract

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon entity with improved clinical outcome over time due to utilization of advanced diagnostic tools and effective treatment modalities. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature. Case Description: It is a case series of 3 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 2 patients who had identifiable underlying cause and lifelong for 1 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 3 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Two patients had complete recanalization of obstructed venous sinuses, while 1 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI. Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.

Published in	International Journal of Neurosurgery (Volume 4, Issue 2)
DOI	10.11648/j.ijn.20200402.14
Page(s)	41-45
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Cerebral Venous Sinus Thrombosis, Intracerebral Hemorrhage, Direct Thrombin Inhibitors, Dabigatran, Recanalization of Dural Sinuses

References

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[2]	Dentali F, Gianni M, Crowther MA, Ageno W. Natural history of cerebral vein thrombosis: a systematic review. Blood. 2006; 108 (4): 1129-34.
[3]	Stam J. Thrombosis of the cerebral veins and sinuses. The New England journal of medicine. 2005; 352 (17): 1791-8.
[4]	Chaturbedi A, Shah R, Koju R, Devkota UP. Review of Patients with Cerebral Venous Sinus Thrombosis (CVST) in a Premier Neuroscience Institute in Nepal. International Journal of Innovative Studies in Medical Sciences. 2019; 3 (1): 28-34.
[5]	Einhaupl K, Bousser MG, de Bruijn SF, Ferro JM, Martinelli I, Masuhr F, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. European journal of neurology. 2006; 13 (6): 553-9.
[6]	Bose G, Graveline J, Yogendrakumar V, Fergusson D, Dowlatshahi D. Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review protocol. Systematic reviews. 2019 Dec; 8 (1): 99.
[7]	Frontera JA, Lewin III JJ, Rabinstein AA, et al. Guideline for reversal of antithrombotics in intracranial hemorrhage. Neurocrit Care. 2015; 24 (1): 6-46.
[8]	Pollack Jr CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015; 373 (6): 511-20.
[9]	Lafitte F, Boukobza M, Guichard JP, Hoeffel C, Reizine D, Ille O, et al. MRI and MRA for diagnosis and follow-up of cerebral venous thrombosis (CVT). Clinical radiology. 1997; 52 (9): 672-9.
[10]	Coutinho J, de Bruijn SF, Deveber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev. 2011 (8): CD002005.
[11]	Gómez-Outes A, Terleira-Fernández AI, Calvo-Rojas G, Suárez-GeaML, Vargas-Castrillón E. Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups. Thrombosis. 2013: 640723, 1-18.
[12]	Van Ryn J; Stangier J; Haertter S; Liesenfeld KH; Wienen W; Feuring M; Clemens A (June 2010). Dabigatran etexilate – a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thrombosis and Haemostasis. 2010; 103 (6): 1116–27.
[13]	Blommel ML, Blommel AL. Dabigatran etexilate: A novel oral direct thrombin inhibitor. American Journal of Health-System Pharmacy. 2011; 68 (16): 1506–19.

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APA Style

Abhishek Chaturbedi, Jitendra Thakur. (2020). Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). International Journal of Neurosurgery, 4(2), 41-45. https://doi.org/10.11648/j.ijn.20200402.14

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ACS Style

Abhishek Chaturbedi; Jitendra Thakur. Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). Int. J. Neurosurg. 2020, 4(2), 41-45. doi: 10.11648/j.ijn.20200402.14

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AMA Style

Abhishek Chaturbedi, Jitendra Thakur. Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). Int J Neurosurg. 2020;4(2):41-45. doi: 10.11648/j.ijn.20200402.14

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@article{10.11648/j.ijn.20200402.14,
  author = {Abhishek Chaturbedi and Jitendra Thakur},
  title = {Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)},
  journal = {International Journal of Neurosurgery},
  volume = {4},
  number = {2},
  pages = {41-45},
  doi = {10.11648/j.ijn.20200402.14},
  url = {https://doi.org/10.11648/j.ijn.20200402.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20200402.14},
  abstract = {Background: Cerebral venous sinus thrombosis (CVST) is an uncommon entity with improved clinical outcome over time due to utilization of advanced diagnostic tools and effective treatment modalities. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature. Case Description: It is a case series of 3 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 2 patients who had identifiable underlying cause and lifelong for 1 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 3 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Two patients had complete recanalization of obstructed venous sinuses, while 1 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI. Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.},
 year = {2020}
}

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TY  - JOUR
T1  - Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)
AU  - Abhishek Chaturbedi
AU  - Jitendra Thakur
Y1  - 2020/08/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijn.20200402.14
DO  - 10.11648/j.ijn.20200402.14
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 41
EP  - 45
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20200402.14
AB  - Background: Cerebral venous sinus thrombosis (CVST) is an uncommon entity with improved clinical outcome over time due to utilization of advanced diagnostic tools and effective treatment modalities. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature. Case Description: It is a case series of 3 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 2 patients who had identifiable underlying cause and lifelong for 1 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 3 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Two patients had complete recanalization of obstructed venous sinuses, while 1 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI. Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.
VL  - 4
IS  - 2
ER  -

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Author Information

Abhishek Chaturbedi

Department of Neurosurgery, Manmohan Memorial Medical College and Teaching Hospital, Swoyambhu, Kathmandu, Nepal
Jitendra Thakur

Department of Neurosurgery, Manmohan Memorial Medical College and Teaching Hospital, Swoyambhu, Kathmandu, Nepal

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Plain Text BibTeX RIS

APA Style

Abhishek Chaturbedi, Jitendra Thakur. (2020). Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). International Journal of Neurosurgery, 4(2), 41-45. https://doi.org/10.11648/j.ijn.20200402.14

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ACS Style

Abhishek Chaturbedi; Jitendra Thakur. Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). Int. J. Neurosurg. 2020, 4(2), 41-45. doi: 10.11648/j.ijn.20200402.14

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AMA Style

Abhishek Chaturbedi, Jitendra Thakur. Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST). Int J Neurosurg. 2020;4(2):41-45. doi: 10.11648/j.ijn.20200402.14

Copy | Download

@article{10.11648/j.ijn.20200402.14,
  author = {Abhishek Chaturbedi and Jitendra Thakur},
  title = {Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)},
  journal = {International Journal of Neurosurgery},
  volume = {4},
  number = {2},
  pages = {41-45},
  doi = {10.11648/j.ijn.20200402.14},
  url = {https://doi.org/10.11648/j.ijn.20200402.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20200402.14},
  abstract = {Background: Cerebral venous sinus thrombosis (CVST) is an uncommon entity with improved clinical outcome over time due to utilization of advanced diagnostic tools and effective treatment modalities. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature. Case Description: It is a case series of 3 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 2 patients who had identifiable underlying cause and lifelong for 1 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 3 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Two patients had complete recanalization of obstructed venous sinuses, while 1 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI. Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Direct Thrombin Inhibitors as the Primary Treatment Modality for Cerebral Venous Sinus Thrombosis (CVST)
AU  - Abhishek Chaturbedi
AU  - Jitendra Thakur
Y1  - 2020/08/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijn.20200402.14
DO  - 10.11648/j.ijn.20200402.14
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 41
EP  - 45
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20200402.14
AB  - Background: Cerebral venous sinus thrombosis (CVST) is an uncommon entity with improved clinical outcome over time due to utilization of advanced diagnostic tools and effective treatment modalities. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature. Case Description: It is a case series of 3 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 2 patients who had identifiable underlying cause and lifelong for 1 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 3 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Two patients had complete recanalization of obstructed venous sinuses, while 1 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI. Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.
VL  - 4
IS  - 2
ER  -

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