Observation On The Efficacy Of New Anticoagulants In The Treatment Of Cerebral Venous And Sinus Thrombosis

BackgroundCerebral venous and sinus thrombosis(CVST)refers to a relatively rare type of cerebrovascular disease and a clinical feature that is caused by non-infectious or infectious factors and is characterized by intracranial venous vascular occlusion,often accompanied by an increase in intracranial pressure caused by cerebrospinal fluid absorption disorders.Since the successful application of anticoagulant drugs in the treatment of CVST in the1940 s,anticoagulant therapy has been the preferred treatment for cerebral venous and sinus thrombosis.With the advancement of science and technology,New anticoagulants with high efficacy and safety have been developed with less adverse reaction by researchersless and have been widely used in the prevention of thrombotic diseases and atrial fibrillation,but there are few studies on their treatment of CVST,and the clinical effect and safety need further research.ObjectiveIn recent years,dabigatran is the first new anticoagulant drug to be successfully developed.The efficacy and safety of its anticoagulant effect have been verified in large-scale studies.It has been widely used in the prevention of patients with non-valvular atrial fibrillation and thrombotic diseases.However,there are few clinical studies of dabigatran in the treatment of cerebral venous and sinus thrombosis,and the efficacy and safety need to be verified.This article retrospectively analyzes the details of patients with intracranial venous system thrombosis hospitalized in Henan Provincial People's Hospital to further clarify the effectiveness and safety of dabigatran and warfarin in the treatment of intracranial venous thrombosis.MethodsThe detailed data of Cerebral venous and sinus thrombosis patients who were hospitalized in Henan Provincial People's Hospital from January 2017 to December 2018 were continuously collected,including: general information,clinical manifestations,imaging findings,other auxiliary examinations,prognosis,adverse reaction rates.Patients who meet the inclusion/exclusion requirements are divided into dabigatran group and warfarin group according to the medication situation.Both groups of patients are given conventional treatment,and if necessary,symptomatic treatment is given.First,giving low-molecular-weight heparin,adjusting the applied dose according to the patient's weight,subcutaneous injection,2 times / day;after the condition is stable,starting oral warfarin or dabigatran,dabigatran group: oral dabigatran capsules 110 mg,2 times / day;warfarin group: oral warfarin Sodium tablets 3mg 1 time / day.During the medication period,the two groups of patients were regularly re-examined for coagulation function,and the drug dose was appropriately adjusted according to the test results.All patients were re-examined at the outpatient clinic for 6 months(6m±10d)of treatment,recording clinical manifestations,bleeding and other adverse events,medication status and mRS score,Test liver and kidney function,coagulation 4 items,electrocardiogram,MRI/MRV.Observe and compare the treatment effect and adverse reaction rate of the two groups of patients at 6months.The primary outcome measure was good functional outcome at 6 months after treatment and was defined as a modified Rank n scale score of 0-2.Secondary outcome measures included affected sinus recanalization rates and bleeding rates.ResultsA total of 152 patients with CVST were included,including 34 in the dabigatran group and 118 in the warfarin group.There was no significant difference in demographic and baseline data between the two groups.At 6 months of treatment,the functional outcomes were good in the dabigatran and warfarin groups(94.1% vs.93.2%;X = 0.043,P= 0.836)and the rate of affected sinus recanalization(94.1% vs.93.2%);X = 0.043,P =0.836)were not statistically significant.The incidence of bleeding was significantly lower in the dabigatran group than in the warfarin group(8.8% vs 27.1%;x = 4.985,P = 0.026).There was no significant difference in the incidence of minor bleeding between the two groups(8.8% vs 16.1%;x = 0.618,P = 0.432),but the incidence of severe bleeding in the dabigatran group was significantly lower than in the warfarin group(0% vs 11.0%;Fisher exact test P = 0.074).There were no deaths in the dabigatran group and 2 deaths in the warfarin group,of which one female patient died during pregnancy from CVST recurrence at 4 months of treatment,and one male patient died from acute myocardium at 2 months of treatment Infarct.There was no significant difference in mortality between the two groups(0% vs 1.7%;Fisher's exact test P = 1.000).ConclusionThe efficacy of dabigatran is not less effective than warfarin in the treatment of cerebral venous and sinus thrombosis patients,and the risk of bleeding complications is lower and the safety may be higher...