Prevalence and Significance of Multiple Hypercoagulable Conditions in Cerebral Venous Thrombosis: 12 years of Experience in a Referral Center
Ahmad Al-Awwad1, Ahmer Asif3, David Gordon1, Linda Hershey2, Veronica Moreno Gomez4, Zainab Al Obaidi2, Chao Xu2, Calin Prodan1
1Neurology, University of Oklahoma Health Sciences Center, 2University of Oklahoma Health Sciences Center, 3Barrow Neurological Institute, 4Department of Neurology
Objective:
We aimed to calculate the prevalence of different hypercoagulable conditions in our sample of patients with CVT and to determine the clinical and laboratory predictors of CVT severity.
Background:
Cerebral vein thrombosis (CVT) is a rare manifestation of venous thromboembolism (VTE) with a highly variable presentation and clinical course with mortality rate ranges between 2% - 8%. The relationship between CVT severity and hypercoagulable states is not fully understood and has never been studied before.
Design/Methods:
We retrospectively reviewed confirmed CVT cases among adults hospitalized in our institution between 2009 and 2021. We calculated the prevalence of the following hypercoagulable factors: antiphospholipid syndrome, factor VII, VIII, and XI, protein C and S deficiency, APC resistance, factor V Leiden, antithrombin deficiency, prothrombin mutation, MTHFR mutation, lipoprotein-a, and sickle cell disease. We used logistic regression to analyze the association between different variables and CVT severity (defined as ICU stay or being discharged to nursing home or long-term care, or death).
Results:
184 patients were found, mean age 43.9, 56.0% women, and 74.5% white. 102 patients (55.4%) required ICU care, 148 (80.43%) had good discharge destinations (home or rehab), and 17 patients (9.2%) died. Head trauma was the most prevalent comorbidity (47 cases, 25.5%), followed by recent craniectomy (22 cases, 12.0%). Hypercoagulable profile was sent in 75 cases (40.8%) among which, 89.3% has at least one abnormal lab. There was an association between CVT severity and the presence of any comorbidity. No statistical evidence of any correlation between any of the hypercoagulable conditions and CVT severity.
Conclusions:
Hypercoagulable conditions do NOT predict CVT severity. However, they remain an important tool to establish the etiology of CVT and to determine the length of treatment.