Examining Specialty and Regional Trends in Anticoagulant Management of Cerebral Venous Thrombosis
Shravani Khisti1, Neel Deshpande2, Anshal Vyas1, Kevna Konduru1, Sai Kumar Reddy Pasya2
1University of Missouri Kansas City School of Medicine, 2University of Kansas
Objective:
This study examines the association between physician specialty, patient demographics, and the choice of warfarin or DOACs in CVT treatment.
Background:
Cerebral Venous Thrombosis (CVT) is a rare but potentially life-threatening condition caused by thrombosis within the brain’s venous sinuses. Anticoagulation is the mainstay of treatment, with warfarin traditionally used for long-term management. However, warfarin’s narrow therapeutic index and complex monitoring requirements increase risks of toxicity. Recently, Direct Oral Anticoagulants (DOACs) have emerged as alternatives for subacute and chronic CVT treatment, offering easier dosing and fewer monitoring needs.
Design/Methods:
A HealthFacts database of patients aged 0–89, admitted with a diagnosis of CVT based on ICD-9 and ICD-10 codes was analyzed. Among the 1000 randomly de-identified patients, 686 patients were given DOACs or Warfarin. We used a logistic regression, correlation analysis, and chi-squared test model to assess the correlation between region, medical speciality, and anticoagulant prescription. A p-value less than 0.05 was considered significant.
Results:
686 patients were included with the majority being female (56%) and males making up a minority (44%). Average age of patients was 40.09 years. DOACs were given to 49.7% of patients. There was a significant association between medical specialties and anticoagulant use with Emergency and Internal Medicine being more likely to prescribe warfarin. Neonatology and Hematology/Oncology were less likely to prescribe warfarin (p= 0.00027). The Northeast region of the United States was more likely to prescribe warfarin by 43% (p-value = 0.0044).
Conclusions:
This study reveals significant differences in how various medical specialties, specifically Emergency and Internal Medicine, and regions manage CVT through anticoagulant therapy, particularly with respect to warfarin and DOACs. These findings highlight the importance of challenging traditions and specialty and region specific guidelines to optimize treatment strategies for CVT. Further research is warranted to explore how these prescribing patterns impact long-term patient outcomes in CVT management.
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