COMPARISON OF WARFARIN AND RIVAROXABAN IN TREATMENT OF CEREBRAL VENOUS SINUS THROMBOSIS

Background: Cerebral venous sinus thrombosis (CVST) refers to a distinct stroke type accounting for 0.5% to 1% of all strokes. Standard treatment for CVST with warfarin is limited by the need for continuous monitoring of anticoagulation with INR. A simple solution to some of these issues could be administration of an oral anticoagulant that does not require laboratory monitoring yet is effective as a single agent for the treatment of acute venous thromboembolism and for continued treatment. Rivaroxaban is one such medicine that can solve this problem. Methodology: It was an open label interventional clinical quasi-controlled Trial conducted at Department of Neurology, Sir Ganga Ram Hospital/Fatima Jinnah Medical University, Lahore for duration of 20 months from January, 2017 to August, 2018. Patients were randomly divided into two groups (Group Warfarin, and Group Rivaroxaban) using computer generated random number table. Treatment started with low molecular weight heparin (Enoxaparin 1mg/kg body weight/day) for 5 to 7 days depending upon improvement in neurological status. Group Rivaroxaban was given Rivaroxaban 15mg twice a day for 21 days followed by 20 mg daily for 12 weeks. Group Warfarin was given warfarin starting with a dose of 5mg and titrating to a target INR 2.0 to 3.0. Patients were followed over 6 months. Results: Overall 30 patients were included in the study. Group Warfarin includes 15 patients and group rivaroxaban also includes 15 patients. Detailed characteristics of all patients in both groups have been summarized in table I. Female patients were 11 (73.33% in group warfarin and 10 (66.66%) in group rivaroxaban. Overall, warfarin and rivaroxaban both showed efficacy in treatment of cerebral venous sinus thrombosis without any significant difference betweem two groups (P-Value= 0.543). Table II. Overall efficacy was upto 90%. Conclusion: In sum, this study demonstrates that rivaroxaban is effective in managing CVST similar to warfarin. Rivaroxaban can be preferred treatment option owing to its safety as no monitoring is needed. Warfarin if monitored adequately and INR maintained within target range can be equally safe in this regard. Key Words: Cerebral Venous Sinus Thrombosis, Warfarin, Rivaroxaban