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Wajeeha Qayyum
Zaland Yousafzai
Sohail Khan
Muhammad Shahid Iqbal
Danish Nabi
Malghalara Afridi


Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke. Anticoagulation with heparin and warfarin is the recommended treatment. Direct Oral Anticoagulants (DOACs) have shown efficacy and safety in other thrombotic conditions and are being investigated for use in CVST. Our study aims to investigate the clinical outcomes of patients with CVST treated with Rivaroxaban.

Methods: This prospective observational study was carried out in Rehman Medical Institute for 20 months (August 2021 to April 2023). Patients aged 18-60 years with clinically stable CVST were enrolled in study. Patients were treated with heparin followed by rivaroxaban, and follow-up visits were scheduled at 3, 6 and 12months. The primary outcome included recanalization, secondary outcomes included bleeding episodes, non-resolution of CVST, time to recanalization, recurrence of VTE, and functional recovery of the patient. Information was recorded in predefined proforma, and anticoagulation duration was based on guidelines.

Results: The study included 18 patients with CVST. The majority of patients were female (83.3%) with a mean age of 37.55±11.77 years. The cause of CVST was undetermined in most cases (61.1%), followed by postpartum (22.2%) and pregnancy (11.1%). Multiple sinuses were involved in half of the cases. At 3 months follow-up, full recanalization was achieved in 38.9%. At 6 months follow-up, full recanalization was seen in 81.8% of patients. No clinically relavant bleeding event was observed. There was no recurrence of CVST at 1-year follow up. All patients achieved full recovery NIHSS 0.

Conclusion: Rivaroxaban is a safe and efficacious treatment option in CVST.

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