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Is a minimum duration of 5 days of unfractionated heparin infusion necessary before transition to oral anticoagulation in cerebral venous thrombosis? a retrospective chart review

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Abstract

In managing cerebral venous sinus thrombosis (CVT), the standard approach has been administering parenteral anticoagulation for at least five days, despite limited supporting evidence. This study aimed to determine the optimal duration of parenteral anticoagulation for CVT patients and its potential impact on their functional outcomes upon discharge. This retrospective observational cohort study was conducted across multiple healthcare centers and included adult CVT patients who received varying durations of parenteral anticoagulation: less than 5 days (n = 25) or 5 days or more (n = 16). The primary focus was on the duration of acute anticoagulation treatment, with secondary endpoints including hospital stay length and functional outcomes. The study found that a shorter duration of anticoagulation treatment (< 5 days) was linked to more favorable outcomes, as measured by the modified Rankin Scale (mRS) (68% vs. 25%, RR = 0.37, CI 0.15–0.90, p = 0.007). However, regression analysis showed non statistically significant associations for all variables except gender. Female patients were significantly more likely to receive a shorter duration of anticoagulation (Odds Ratio: 2.6, 95% CI: 2.2–3.1, P-Value: <0.001). These findings suggest a potential connection between shorter anticoagulation duration (< 5 days) and improved CVT patient outcomes, as indicated by their mRS scores at discharge. The observed relationship between female gender and shorter anticoagulation duration warrants further exploration. Nevertheless, caution is necessary when interpreting these findings due to the small sample size and specific patient characteristics. Further research in a larger and more diverse cohort is essential to validate these results and understand their implications fully.

Highlights

Acute cerebral venous thrombosis (CVT) management involves treatment with parenteral anticoagulation prior to transitioning to an oral anticoagulant.

Although a recent randomized control trial has utilized a minimum of 5 days, there remains a lack of guidance surrounding the optimal treatment duration of parenteral anticoagulation prior to transitioning to oral therapy.

Patients with CVT may attain stability within fewer than 5 days of treatment. This often prompts clinicians to reconsider the necessity of prolonged parenteral anticoagulation.

In this retrospective, observational cohort study, CVT patients treated with < 5 days of parenteral anticoagulation achieved a favorable functional outcome at discharge.

Further research is needed to establish a causal relationship between functional outcomes and the duration of parenteral anticoagulation.

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  1. Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA

    Ariel N. Carrion, Teresa A. Allison & Sophie Samuel

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  1. Ariel N. Carrion
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Correspondence to Sophie Samuel.

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Carrion, A.N., Allison, T.A. & Samuel, S. Is a minimum duration of 5 days of unfractionated heparin infusion necessary before transition to oral anticoagulation in cerebral venous thrombosis? a retrospective chart review. J Thromb Thrombolysis 57, 691–698 (2024). https://doi.org/10.1007/s11239-024-02950-x

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