Comparison of Novel Oral Anticoagulants and Vitamin K Antagonists in Patients With Cerebral Venous Sinus Thrombosis on Efficacy and Safety: A Systematic Review

Vitamin K antagonists (VKAs) are guideline-suggested subacute anticoagulants for cerebral venous sinus thrombosis (CVST), although there is potential hemorrhage risk in clinical use. In the last decade, novel oral anticoagulants (NOACs) have been applied as an alternative to VKAs in some kinds of thromboembolic diseases. Whether NOACs could replace VKAs in CVST treatment remains unclear. We conducted a comparison between the two types of medicines on efficacy and safety for the treatment of CVST based on the present clinical evidence from a literature search. Six studies [four retrospective studies, one prospective study, and 1 randomized clinical trial (RCT)] including 398 patients were included. Data suggested no significant difference between NOACs and VKAs in terms of recurrence of venous thrombotic events (VTEs) or death [risk ratio (RR) = 0.34, 95% confidence interval (CI) 0.06–1.98], partial recanalization (RR = 0.97, 95% CI 0.93–1.14), and overall hemorrhage events (RR = 0.86, 95% CI 0.47–1.58). In conclusion, the application of NOACs for CVST is similar to that of VKAs in terms of efficacy and safety.