Cerebral Venous Sinus Thrombosis (CVST) is typically managed using parenteral heparin with transition to oral anticoagulation (OAC) for long-term treatment. Although the cornerstone OAC therapy for CVST remains warfarin, recent studies and meta-analyses have demonstrated that DOACs provide similar benefit. Despite the completion of several RCTs, evidence is still limited as the condition affects a particular subset of population. 

We searched PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov since inception for Randomized Controlled Trials (RCTs) that evaluated DOACs versus warfarin in adults with CVST. Primary efficacy outcome was recurrent venous thrombosis. Other outcomes included major hemorrhage and lack of recanalization.

A total of 530 patients were included, comprising 281 treated with DOACs and 249 with warfarin. The mean age of participants was 32.1 ± 12.3 years, with a female predominance (62.5%). The pooled analysis demonstrated no statistically significant difference between DOACs and warfarin in the risk of recurrent CVT (RR: 1.45; 95% CI: 0.37–5.63; p = 0.59; I² = 19.9%). Similarly, there was no significant difference in the risk of major hemorrhage (RR: 0.65; 95% CI:0.22–1.96; p = 0.45; I² = 0%) or failure of recanalization (RR: 1.10; 95% CI: 0.72–1.69; p =0.64; I² = 6.11%). Overall, these findings suggest that DOACs offer comparable safety and efficacy profiles to warfarin for the treatment of cerebral venous sinus thrombosis, with minimal heterogeneity across studies.