Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis of 4,929 Patients

source extracted confidence: high 2026-04-09
#humans #vitamin-k #anticoagulants #administration-oral #intracranial-thrombosis

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis of 4,929 Patients

Waseem et al., 2025 | Clin Appl Thromb Hemost | Meta Analysis

Citation

Waseem Muhammad Hassan, Abideen Zain Ul, ... Thada Pawan Kumar. Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis of 4,929 Patients. Clin Appl Thromb Hemost. 2025;31:10760296251405417. doi:10.1177/10760296251405417

Abstract

BackgroundCerebral venous thrombosis (CVT), a rare cause of stroke, primarily occurs in young individuals. The established treatment regimen involves anticoagulation with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Although direct oral anticoagulants (DOACs) have emerged as a promising alternative, their efficacy and safety remain unclear. This meta-analysis compared the efficacy and safety of DOACs versus VKA in managing CVT.MethodsElectronic databases, including PubMed, Cochrane Library, and ScienceDirect, were searched from inception until April 2025. Risk ratios (RR) with a 95% Confidence interval (CI) were pooled under the random effects model in the Review Manager 5.4.1. Quality assessment was done through the Cochrane risk of bias (RoB 2.0) tool and the Newcastle Ottawa Scale (NOS). Subgroup analyses based on study design and different types of DOACs were carried out.ResultsThirty-one studies, including five randomized controlled trials (RCTs) and 26 observational studies, were included in this meta-analysis. Our analysis showed a significant reduction in the risk of recurrent venous thromboembolism (VTE) in the DOACs arm compared to VKA (RR = 0.84; 95%CI: [0.71,0.99]; p = 0.04; I2 = 0%). Similarly, the DOACs showed significant superiority over VKA regarding the intracranial hemorrhage (ICH) (RR = 0.67; 95%CI: [0.50,0.89]; p = 0.007; I2 = 0%). Other endpoints, including major hemorrhage (RR = 0.70; 95%CI:[0.42,1.15]; p = 0.16; I2 = 0%), all-cause mortality (RR = 0.96; 95%CI:[0.68,1.35]; p = 0.81; I2 = 0%), and full recanalization (RR = 0.92; 95%CI:[0.82,1.03]; p = 0.16; I2 = 21%), are comparable between the two arms.ConclusionDOACs showed a significant reduction in the risk of recurrent VTE and ICH compared to VKA, whereas other endpoints are comparable. Further RCTs with a robust sample size are required to validate and confirm these findings.

Key Findings

Further RCTs with a robust sample size are required to validate and confirm these findings.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population young individuals
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Vitamin K
  • Anticoagulants
  • Administration, Oral
  • Intracranial Thrombosis
  • Venous Thrombosis

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09