Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis.

Abstract

BACKGROUND AND PURPOSE:

This analysis examined the frequency of dural arteriovenous fistulae (dAVF) after cerebral venous thrombosis (CVT) in patients included in a randomized controlled trial comparing dabigatran etexilate with dose-adjusted warfarin (RE-SPECT CVT [A Clinical Trial Comparing Efficacy and Safety of Dabigatran Etexilate With Warfarin in Patients With Cerebral Venous and Dural Sinus Thrombosis]), who had systematic follow-up magnetic resonance (MR) imaging.

METHODS:

RE-SPECT CVT was a Phase 3, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded end point adjudication. We allocated patients with acute CVT to dabigatran 150 mg twice daily or dose-adjusted warfarin, for 24 weeks and obtained a standardized MR protocol including time-of-flight MR angiography, 3-dimensional phase-contrast venography, and 3-dimensional contrast-enhanced MR venography at the end of the treatment period. A blinded adjudication committee assessed the presence of dAVF in a predefined substudy of the trial.

RESULTS:

We analyzed development of dAVF in 112 of 120 randomized patients; 57 allocated to dabigatran and 55 to warfarin. For 3 (2.7%) of these 112 patients, quality of follow-up imaging was insufficient to evaluate dAVF. A dAVF (Borden I) was found in 1 patient (0.9%) allocated to warfarin; however, this dAVF was already present at baseline. The patient did not present with hemorrhage at baseline or during the trial and was asymptomatic at follow-up.

CONCLUSIONS:

Despite systematic imaging, we found no new dAVF 6 months after CVT. Routine follow-up cerebral MR angiography aiming to detect new dAVF 6 months after CVT has a very low yield. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02913326.

• Authors: José M Ferro, Jonathan M Coutinho, Olav Jansen, Martin Bendszus, Francesco Dentali, Adam Kobayashi, Bas van der Veen, Corinna Miede, Jorge Caria, Holger Huisman, Hans-Christoph Diener, RE-SPECT CVT Study Group
• Journal: Stroke (Stroke) Vol. 51 Issue 11 Pg. 3344-3347 (11 2020) ISSN: 1524-4628 [Electronic] United States
• PMID: 32972315 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Antithrombins
• Warfarin
• Dabigatran

Topics

• Adult
• Anticoagulants (therapeutic use)
• Antithrombins (therapeutic use)
• Arteriovenous Fistula (diagnostic imaging, epidemiology)
• Central Nervous System Vascular Malformations (diagnostic imaging, epidemiology)
• Cerebral Angiography
• Cerebral Veins
• Cranial Sinuses (diagnostic imaging)
• Dabigatran (therapeutic use)
• Female
• Humans
• Imaging, Three-Dimensional
• Intracranial Thrombosis (drug therapy, epidemiology)
• Magnetic Resonance Angiography
• Male
• Meningeal Arteries
• Middle Aged
• Randomized Controlled Trials as Topic
• Secondary Prevention
• Sinus Thrombosis, Intracranial (drug therapy, epidemiology)
• Venous Thrombosis (drug therapy, epidemiology)
• Warfarin (therapeutic use)