腦靜脈栓塞 (cerebral venous thrombosis, CVT) 相較於動脈栓塞引起的腦中風，發生率較低，美國心臟協會 (American Heart Association, AHA) 與歐洲腦中風學會(European Stroke Organization, ESO) 所發布的治療指引建議，CVT 在急性期後以口服抗凝血劑warfarin 做為栓塞復發的次級預防。由於直接口服抗凝血劑 (direct oral anticoagulant, DOAC) 相較於warfarin，具有不須頻繁監測凝血功能與劑量調整的優勢，目前已發表的DOAC 於CVT 患者之案例報告與文獻，僅dabigatran 有隨機對照研究，結果顯示栓塞復發與出血風險比例相近，雖礙於研究人數限制難以比較兩者優劣，但仍可得知療效與安全性不亞於warfarin；而rivaroxaban 目前有較多相關研究且尚有臨床試驗正進行中，回顧性研究顯示，與warfarin 相比在CVT 各項預後指標均可見相似效果，且皆無重大出血事件與血栓復發。Apixaban 與edoxaban 目前僅案例報告，臨床證據有限，但仍可見個案在腦靜脈的影像學追蹤檢查中，達到良好的栓塞疏通程度。本文將彙整相關研究結果，作為未來治療選擇之參考依據。

 

Patients with cerebral venous thrombosis (CVT) have a lower stroke incidence than those with cerebral arterial thrombosis. The American Heart Association and European Stroke Organization clinical practice guidelines for CVT recommended that patients receive warfarin for secondary prevention of recurrent thrombosis after acute CVT. Direct oral anticoagulants (DOACs) have been widely used in clinical practice due to safety monitoring and dose adjustment advantages. Recently, some case reports and research on DOACs in CVT management have been published. A randomized controlled trial revealed no significant differences in recurrent thrombosis and risk of hemorrhage between dabigatran and warfarin. This trial concluded that warfarin was not inferior despite its small sample size. More rivaroxaban reports have been published as a result of ongoing trials. Retrospective studies showed similar effectiveness in CVT management and statistically insignificant major bleeding events and recurrent thrombosis between warfarin and rivaroxaban. Apixaban and edoxaban were only reported in cases of complete or partial recanalization in venous thrombosis. To provide more options for clinical practice, we reviewed research on DOACs in CVT treatment.

 

Submitted for publication: 2021.11.3; Accepted for publication: 2022.9.20