Characteristics and outcomes of postpartum cerebral venous sinus thrombosis: A subgroup analysis of the ACTION-CVT study

Ton Fang; Liqi Shu; Marwa Elnazeir; Adeel S Zubair; Sami Al Kasab; Kateryna Antonenko; Mirjam R Heldner; Shadi Yaghi; Nils Henninger; ACTION-CVT study collaborators

doi:10.1016/j.jstrokecerebrovasdis.2022.106865

Characteristics and outcomes of postpartum cerebral venous sinus thrombosis: A subgroup analysis of the ACTION-CVT study

J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106865. doi: 10.1016/j.jstrokecerebrovasdis.2022.106865. Epub 2022 Nov 1.

Authors

Ton Fang¹, Liqi Shu², Marwa Elnazeir¹, Adeel S Zubair³, Sami Al Kasab⁴, Kateryna Antonenko⁵, Mirjam R Heldner⁵, Shadi Yaghi², Nils Henninger⁶; ACTION-CVT study collaborators

Affiliations

¹ Department of Neurology, University of Massachusetts, Worcester, MA, USA.
² Department of Neurology, Brown University, Providence, RI, USA.
³ Department of Neurology, Yale University, New Haven, CT, USA.
⁴ Department of Neurology, Medical University of South Carolina, Charleston, SC, USA; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
⁵ Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
⁶ Department of Neurology, University of Massachusetts, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655. Electronic address: [email protected].

PMID: 36332527
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106865

Abstract

Background and purpose: There is a relative paucity of data regarding long-term outcomes and treatment-related complications in women of childbearing age with cerebral venous sinus thrombosis (CVST). We sought to determine whether outcomes differ in women of childbearing age with versus without postpartum CVST.

Methods: We retrospectively analysed 373 non-pregnant females of childbearing age (18-45 years) included in the multicenter observational Anticoagulation in the Treatment of Cerebral Venous Thrombosis study (ACTION-CVT). Comparisons were made between postpartum (first 12 weeks from delivery, n=38 [10.2%]) versus non-postpartum women (n=335 [89.8%]). The primary outcomes of interest were one-year risk of all-cause death, venous thromboembolism (VTE) recurrence, and major hemorrhage (i.e., new or worsening intracranial hemorrhage or major extracranial hemorrhage). Secondary outcomes were the discharge disposition and modified Rankin Scale (mRS) score at discharge and 90 days.

Results: Postpartum status was associated with greater risk of seizures (42.1% versus 20.9%, p=0.003), venous infarction (47.4% versus 29.5%, p=0.025), intracranial hemorrhage (55.3% versus 36.1%, p=0.022), and requirement for neurosurgical treatment (13.2% versus 3.6%, p=0.021). There was no significant association with one year all cause death (N=373 HR=1.35, 95%-CI=0.15-11.87, p=0.784), VTE recurrence (N=373, HR=1.27, 95%-CI=0.45-3.59, p=0.648), major hemorrhage (N=373, HR=1.36, 95%-CI=0.46-4.0, p=0.581) as well as excellent (mRS[0-1]: OR=1.58, 95%-CI=0.4-7.1, p=0.554) and good (mRS[0-2]: OR=0.92, 95%-CI=0.2-4.27, p=0.918) 90-day mRS. Results were similar after adjustment for potential confounders.

Conclusions: Although CVST in the 12-week postpartum period was more frequently associated with early complications, 90-day functional disability and one-year outcomes were similar to women with CVST unrelated to pregnancy.

Keywords: Anticoagulation; Direct oral anticoagulants; Hemorrhage; Outcome; Puerperium; Recurrence; Vitamin K antagonists.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Anticoagulants / adverse effects
Female
Hemorrhage
Humans
Intracranial Hemorrhages
Intracranial Thrombosis* / diagnostic imaging
Intracranial Thrombosis* / drug therapy
Middle Aged
Postpartum Period
Pregnancy
Retrospective Studies
Sinus Thrombosis, Intracranial* / diagnostic imaging
Sinus Thrombosis, Intracranial* / drug therapy
Venous Thromboembolism*
Venous Thrombosis* / diagnostic imaging
Venous Thrombosis* / drug therapy
Young Adult

Substances

Anticoagulants