Ima A. Kusuma
JIH Hospital, Indonesia
Title: The use of new oral anticoagulant in cerebral venous sinus thrombosis: Alternative therapy with excellent result
Biography
Biography: Ima A. Kusuma
Abstract
Introduction: Cerebral venous sinus thrombosis (CVST) is a rare neurovascular disorder with variable clinical presentation. CVST usually affect young individuals and three times more often in women than men. Mainstay therapy for CVST is giving heparin then continued by oral anticoagulant. However, achievement and maintenance of optimal INR is often difficult. One topic that will most likely be examined in the near future is the role of new oral anticoagulants (NOACs) in the treatment of CVST.
Case Report: A 37 years old woman with history of headache for two months admitted to the hospital with mild right sided weakness. She had dyslipidemia and history of taking oral contraceptives several years ago. On physical exam her vital signs were stable and within normal limits. Cerebral CT scan examination showed normal result, then MRI (MRA-MRV) was performed. MRV showed defect at left sinus tranversus. Patient was given new oral anticoagulant, rivaroxaban. It started at dosages of 15 mg twice daily. On the fifth day follow up, the right sided weakness was revealed. Rivaroxaban then continued for 21 days, followed by rivaroxaban 20 mg once daily. On the third months follow up, there were no complications in this patient.
Discussion: In patients with VTE and atrial fibrillation, NOACs are associated with an approximate 50% relative risk reduction in ICHs compared to warfarin. In neurological patients achievement and maintenance of optimal INR is often difficult. Various modifiable factors including diet, choice of drugs and their dosage are important predictors of stability hence should be carefully adjusted. The Rocket trial documented that rivaroxaban, a novel oral anticoagulant, has a lower rate of most concerning bleeds: fatal bleeding and intra cranial haematoma compared to warfarin, which makes it particularly attractive for the treatment of CVST. In this case, the use of rivaroxaban gave excellent result with no complication.
Conclusion: This case suggests a potential role of novel factor Xa inhibitor in the treatment of CVST.
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