The DOAC-CVT study, a large international cohort study led by Amsterdam UMC, focuses on the treatment of cerebral venous thrombosis (CVT) using direct oral anticoagulants (DOACs). Last week, the results were revealed during a plenary session at the World Stroke Conference in Abu Dhabi. The data suggest that patients with CVT can be safely and efficaciously treated with direct oral anticoagulants (DOACs). This finding has important implications for patient management.

Cerebral Venous Thrombosis

“CVT is a rare cause of stroke that primarily affects young and middle-aged adults, especially women,” explains Jonathan Coutinho, stroke neurologist at Amsterdam UMC and principal investigator at Amsterdam Neuroscience and Amsterdam Cardiovascular Sciences, as well as lead researcher on the DOAC-CVT study. “The most common signs and symptoms of CVT are severe headache, focal neurological deficits, intracerebral hemorrhage and epileptic seizures.” The incidence of CVT is on the rise at a global level, calling for additional safe and effective treatments.

Researcher and

stroke neurologist

Jonathan Coutinho

A new treatment

Traditionally, vitamin K antagonists are the oral anticoagulant of choice to treat CVT. However, for more common thrombotic disorders such as deep vein thrombosis of the leg and pulmonary embolism, DOACs have largely replaced the vitamin K antagonists as the standard-of-care.

“In general, DOACs are more patient friendly, as they do not require dose adjustments based on plasma concentrations. They also have a lower risk of intracranial hemorrhage,” says Coutinho. A few small randomized trials have assessed the safety and efficacy of DOACs in patients with CVT, but the sample sizes of these studies were too small to draw firm conclusions. This was the reason to perform the DOAC-CVT study.

DOAC-CVT study

DOAC-CVT was an international, observational cohort study which assessed the safety and efficacy of direct oral anticoagulants (DOACs) for the treatment of CVT. Neurologists from 65 hospitals in 23 countries across five continents included patients with CVT who were treated with a DOAC (401) or vitamin K antagonist (218). After 6 months, the rate of recurrent venous thrombotic events and major bleeding did not differ between those treated with a DOAC compared with vitamin K antagonist.

“In combination with data from other venous thrombotic conditions and previous small, randomised trials in CVT, these data suggest that patients with CVT can be safely and efficaciously treated with a DOAC,” Coutinho explains.

Future research

DOAC-CVT was backed by a grant from the Dutch Thrombosis Foundation. “Despite limited funding, we were able to perform a large international study which has important implications for patient management,” says Coutinho. “To me, this shows the strength of international academic collaboration, especially for conditions that are less common.”

Upon being asked what’s next, Coutinho knows the answer. “In 2023, we organized an international research summit on CVT in Amsterdam, in which researchers and patients together prepared a research agenda in which the most important research questions on CVT have been formulated. With sufficient funding, the international CVT consortium will be able to answer these research questions and thus improve the outcome of patients with CVT worldwide. My aim is to raise this funding and answer every single question on the research agenda.”

The DOAC-CVT study is part of the International Cerebral Venous Thrombosis Consortium. This is an academic research collaboration between CVT experts, and with the overarching aim to gain better insight into the epidemiology, clinical manifestations, treatment, and outcome of cerebral venous thrombosis. Investigators from 34 countries are part of the consortium. Read more about the CVT consortium here.