2026 American Academy of Neurology Abstract Website

Zain ul Abideen¹, Hassan Waseem², Areeba Shoaib³, Nohela Rehman³, Muhammad Osama⁴, Barka Sajid⁵, Muhammad Mukhlis⁶, Muhammad Ansari⁵, Muhammad Ansari⁷, Rowaid Ahmad⁷, Justin Chen⁸, Jamir Pitton Rissardo⁹, Ana Leticia Fornari Caprara⁹, Vishnu Byroju¹⁰, Adam Dmytriw¹¹, Brandon Lucke-Wold¹²
¹King Edward Medical University, ²Allama Iqbal Medical College, ³Dow University of Health Sciences, ⁴Hayatabad Medical Complex, ⁵Jinnah Sindh Medical University, ⁶Ayub Medical College, ⁷UTMB, ⁸Texas A&M College of Medicine, ⁹Cooper University Hospital, ¹⁰Cooper University Healthcare, ¹¹Massachusetts General Hospital, ¹²University of Florida

Objective:

This meta-analysis aims to compare the effectiveness and safety of direct oral anticoagulants (DOACs) with those of vitamin K antagonists (VKAs) in treating cerebral venous thrombosis (CVT).

Background:

CVT is a rare cause of stroke, mainly affecting young people. The standard treatment plan includes anticoagulation with low molecular weight heparin (LMWH) and then VKAs. While DOACs show promise, their effectiveness and safety are still uncertain.

Design/Methods:

Electronic databases, including PubMed, Cochrane Library, and ScienceDirect, were searched from the inception to April 2025. We pooled risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model in Review Manager 5.4.1. To assess quality, we used the Cochrane risk of bias (RoB 2.0) tool and the Newcastle-Ottawa Scale (NOS). We also conducted subgroup analyses based on study design and different types of DOACs.

Results:

Thirty-one studies, comprising 5 randomized controlled trials (RCTs) and 26 observational studies, were included in this meta-analysis. Our analysis revealed a significant decrease in the risk of recurrent venous thromboembolism (VTE) in the DOACs group compared to VKA (RR= 0.84; 95%CI: [0.71,0.99]; p=0.04; I²=0%). Likewise, DOACs showed a significant advantage over VKA in terms of intracranial hemorrhage (ICH) (RR= 0.67; 95%CI: [0.50,0.89]; p=0.007; I²=0%). Other outcomes, 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%), were comparable between the two groups.

Conclusions:

DOACs showed a significant reduction in the risk of recurrent VTE and ICH compared to VKAs, whereas major hemorrhage, all-cause mortality, and full recanalization were comparable.