Predictors of Recurrent Venous Thrombosis After Cerebral Venous Thrombosis
Liqi Shu, Ekaterina Bakradze, Setareh Salehi Omran, James Giles, Jordan Amar, Nils Henninger, Marwa Elnazeir, Ava L. Liberman, Khadean Moncrieffe, Jenny Rotblat, Richa Sharma, Yee Kuang Cheng, Adeel Zubair, Alexis N. Simpkins, Grace Li, Justin Kung, Dezaray Perez, Mirjam R. Heldner, Adrian Scutelnic, Rascha von Martial, Bernhard Siepen, Aaron Rothstein, Ossama Khazaal, David Do, Sami Al Kasab, Line Abdul Rahman, Eva Mistry, Deborah Kerrigan, Hayden Lafever, Thanh N. Nguyen, Piers Klein, Hugo J. Aparicio, Jennifer Frontera, Lindsey Kuohn, Shashank Agarwal, Christoph Stretz, Narendra Kala, Sleiman ElJamal, Allison Chang, Shawna Cutting, Fransisca Indraswari, Adam de Havenon, Varsha Muddasani, Teddy Y. Wu, Duncan Wilson, Amre Nouh, Daniyal Asad, Abid Qureshi, Justin Moore, Pooja Khatri, Yasmin Aziz, Bryce Casteigne, Muhib Khan, Yao Cheng, Brian Mac Grory, Martin Weiss, Dylan Ryan, Maria Cristina Vedovati, Maurizio Paciaroni, James E. Siegler, Scott Kamen, Siyuan Yu, Christopher R. Leon Guerrero, Eugenie Atallah, Gian Marco De Marchis, Alex Brehm, Tolga Dittrich, Marios Psychogios, Ronald Alvarado-Dyer, Tareq Kass‐Hout, Shyam Prabhakaran, T Honda, David S. Liebeskind, Karen L. Furie, Shadi Yaghi
Abstract
<h3>Background and Objective</h3> Cerebral venous thrombosis (CVT) is a rare cause of stroke carrying a nearly 4% risk of recurrence after 1 year. There are limited data on predictors of recurrent venous thrombosis in patients with CVT. In this study, we aim to identify those predictors. <h3>Methods</h3> This is a secondary analysis of the ACTION-CVT study which is a multicenter 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. <h3>Results</h3> Nine hundred forty-seven patients were included with a mean age of 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 (interquartile range 120–700) days, there were 5.05 recurrent venous thromboses (37 VTE and 24 de novo CVT) per 100 patient-years. Predictors of recurrent venous thrombosis were Black race (adjusted hazard ratio [aHR] 2.13, 95% CI 1.14–3.98, <i>p</i> = 0.018), history of VTE (aHR 3.40, 95% CI 1.80–6.42, <i>p</i> < 0.001), and the presence of one or more positive antiphospholipid antibodies (aHR 3.85, 95% CI 1.97–7.50, <i>p</i> < 0.001). Sensitivity analyses including events only occurring on oral anticoagulation yielded similar findings. <h3>Discussion</h3> 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.