Comparison of Anticoagulation Strategies in Cerebral Venous Thrombosis

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 06

Ryan D. Bloesser, PharmD (he/him/his)

University Health, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
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Crystal Franco-Martinez, PharmD, BCPS

Clinical Pharmacy Specialist, Anticoagulation
University Health

Disclosure information not submitted.
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Caroline Conner, PharmD, BCCCP

Clinical Pharmacy Specialist, Critical Care
University Health

Disclosure information not submitted.
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Kelly Reveles, PharmD, PhD, BCPS, BCIDP

Associate Professor of Pharmacotherapy and Translational Sciences
The University of Texas at Austin College of Pharmacy

Disclosure information not submitted.
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Colleen Barthol, PharmD, BCCCP, FNCS

Lead Clinical Pharmacy Specialist, Neurocritical Care
University Health

Disclosure information not submitted.

Introduction: Cerebral venous thrombosis (CVT) is a rare condition where a thrombus forms within the dural venous sinuses, cerebral veins, or both. Guidelines for CVT management recommend parenteral anticoagulation followed by oral anticoagulation. Though evidence supporting direct-acting oral anticoagulants (DOACs) for CVT treatment exists, optimal parenteral lead-in duration, and DOAC selection and dosing remain unclear. This study evaluated anticoagulation prescribing strategies and clinical outcomes for CVT treatment at a large tertiary care academic medical center.

Methods: This was a retrospective cohort study of patients 18 years or older hospitalized from July 2020-October 2024 and diagnosed with CVT. Patients were categorized by anticoagulation regimen and by DOAC dosing strategy for those that received apixaban or rivaroxaban (load vs. non-load). The primary outcome was major bleeding during the index admission. Secondary outcomes included new intracranial hemorrhage (ICH), ICH expansion, and new or worsening CVT during the index admission.

Results: Fifty-three patients were included and categorized into four treatment groups: parenteral lead-in to DOAC (n=40), parenteral lead-in to warfarin (n=4), parenteral only (n=4), and DOAC only (n=5). Major bleeding occurred in 11 patients (20.8%) and did not differ when compared among all groups (p=0.058). Major bleeding occurred more often in the parenteral only group compared to the parenteral lead-in to DOAC group (75% vs. 20%, p=0.043). There was no significant difference in major bleeding between patients who did and did not receive the loading dose strategy for apixaban or rivaroxaban (21% vs. 16%, p=0.689).

Conclusions: Major bleeding did not significantly differ when evaluating all treatment groups but did differ when comparing the parenteral only group with the parenteral lead-in to DOAC group. Larger prospective studies are needed to further evaluate the optimal anticoagulation regimen for CVT treatment.