Predictors of Recurrent Venous Thrombosis After Cerebral Venous Thrombosis: Analysis of the ACTION-CVT Study

Liqi Shu, Department of Neurology, Brown University, Providence, RI, USA.
Ekaterina Bakradze, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Setareh Salehi Omran, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
James Giles, Department of Neurology, Washington University, Saint Louis, MO, USA.
Jordan Amar, Department of Neurology, Washington University, Saint Louis, MO, USA.
Nils Henninger, Department of Neurology, University of Massachusetts, Worcester, MA, USA.
Marwa Elnazeir, Department of Neurology, University of Massachusetts, Worcester, MA, USA.
Ava Liberman, Department of Neurology, Weill Cornell Medical Center, New York, NY, USA.
Khadean Moncrieffe, Department of Neurology, Montefiore Medical Center, New York, NY, USA.
Jenny Rotblat, Department of Neurology, Montefiore Medical Center, New York, NY, USA.
Richa Sharma, Department of Neurology, Yale University, New Haven, CT, USA.
Yee Cheng, Department of Neurology, Yale University, New Haven, CT, USA.
Adeel S. Zubair, Department of Neurology, Yale University, New Haven, CT, USA.
Alexis Simpkins, Department of Neurology, University of Florida, Gainesville, FL, USA.
Grace Li, Department of Neurology, University of Florida, Gainesville, FL, USA.
Justin Kung, Department of Neurology, University of Florida, Gainesville, FL, USA.
Dezaray Perez, Department of Neurology, University of Florida, Gainesville, FL, USA.
Mirjam R. Heldner, Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Adrian Scutelnic, Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Rascha von Martial, Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Bernhard Siepen, Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Aaron Rothstein, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Ossama Khazaal, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
David Do, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Sami Al Kasab, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Line Abdul Rahman, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Eva A. Mistry, University of Cincinnati, Department of Neurology and Rehabilitation Medicine.
Deborah Kerrigan, Department of Neurology, Vanderbilt University, Nashville, TN, USA.
Hayden Lafever, Department of Neurology, Vanderbilt University, Nashville, TN, USA.
Thanh N. Nguyen, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
Piers Klein, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
Hugo J. Aparicio, Department of Neurology, Boston University School of Medicine, Boston, MA, USA.

Document Type

Journal Article

Publication Date

9-19-2022

Journal

Neurology

DOI

10.1212/WNL.0000000000201122

Abstract

BACKGROUND: and Purpose: Cerebral venous thrombosis (CVT) is a rare cause of stroke carrying a nearly 4% risk of recurrence after 1 year. There is limited data on predictors of recurrent venous thrombosis in patients with CVT. In this study, we aim to identify those predictors. METHODS: This is a secondary analysis of the ACTION-CVT study which is a multi-center international study of consecutive patients hospitalized with a diagnosis of CVT over a 6-year period. Patients with cancer associated CVT, CVT during pregnancy, or CVT in the setting of known antiphospholipid antibody syndrome were excluded per the ACTION-CVT protocol. The study outcome was recurrent venous thrombosis defined as recurrent venous thromboembolism (VTE) or de-novo CVT. We compared characteristics between patients with vs. without recurrent venous thrombosis during follow-up and performed adjusted Cox regression analyses to determine important predictors of recurrent venous thrombosis. RESULTS: 947 patients were included with a mean age was 45.2 years, 63.9% were women, and 83.6% had at least 3-months of follow-up. During a median follow-up of 308 (IQR 120-700) days, there were 5.05 recurrent venous thromboses (37 VTE and 24 CVT) per 100 patient-years. Predictors of recurrent venous thrombosis were Black race (adjusted HR 2.13, 95% CI 1.14-3.98, p = 0.018), prior history of VTE (aHR 3.40, 95% CI 1.80-6.42, p < 0.001) and the presence of one or more positive antiphospholipid antibodies (aHR 3.85, 95% CI 1.97-7.50, p < 0.001). Sensitivity analyses including events only occurring on oral anticoagulation yielded similar findings. CONCLUSION: Black race, history of VTE, and the presence of one or more antiphospholipid antibodies are associated with recurrent venous thrombosis among patients with CVT. Future studies are needed to validate our findings to better understand mechanisms and treatment strategies in patients with CVT.

Department

Neurology

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