Background and hypothesis: Little is known about the relationships between the presence/type of provoking risk factors and the prognosis and optimal duration of anticoagulation in patients with cerebral vein and dural sinus thrombosis (CVT). We aimed to analyze data of treatment and long-term prognosis in patients with CVT classified by the presence and type of provoking risk factors.
Methods: Prospectively recorded data of a tertiary medical center were retrospectively reviewed. Patients with CVT were categorized into three groups by risk factors: unprovoked, those with possibly resolved provoking factors (PR), and those with persistent provoking factors (PP). The baseline characteristics, treatment, and prognosis of these three groups were analyzed.
Results: From 2000 to 2015, 61 patients were registered for CVT, 19 (31.1%) with unprovoked, 11 (18.0%) with PR, and 31 (50.9%) with PP. Median follow-up and duration of anticoagulation were 35 and 8 months, respectively. The PR group consisted of patients with causative drugs or arteriovenous fistula successfully treated. Despite the similarities in baseline characteristics of the three groups, deaths (n=3; P = 0.256) and recurrences (n=7; P = 0.020) were observed only in the PP group. The median interval to death and recurrence were 9 and 13 months, respectively. Death was associated with underlying disease activity, not with CVT progression. Recurrences were associated with lack of initial administration of anticoagulation (P = 0.028); of the seven patients with recurrence, five (71.4%) did not receive anticoagulation at the second event.
Conclusions: Although the prognosis of CVT is generally benign, recurrence and death were observed in the patients with persistent risk factors, suggesting their need for long-term treatment with anticoagulants.