Article type: Systematic Review
Article title: Comparing Efficacy and Safety of Different Anticoagulants in Cerebral Venous Thrombosis: A Systematic Review and Network Meta-Analysis
Journal: Clinical and Applied Thrombosis/Hemostasis
Year: 2026
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Jamir Pitton Rissardo, Muhammad Haris Khan, Kanza Farhan, Ana Leticia Fornari Caprara, Pawan Kumar Thada, Adam A Dmytriw
E-mail: magarpawan87@gmail.com
ABSTRACT
Background: Cerebral venous thrombosis (CVT) is a rare but severe type of stroke, typically treated with vitamin K antagonists (VKAs). This study compares different direct oral anticoagulants (DOACs) with VKAs for the management of CVT. Methods: PubMed, Cochrane Central, and ScienceDirect were searched up to May 2025. A network meta-analysis using a frequentist approach was performed in RStudio version 4.3.3. P-scores were used to rank treatments. The evaluated outcomes included full recanalization, recurrent venous thromboembolism (VTE), major hemorrhage, intracranial hemorrhage (ICH), and mortality. The Cochrane Risk of Bias (RoB 2.0) tool and the Newcastle-Ottawa Scale (NOS) were employed to assess the quality of randomized controlled trials (RCTs) and observational studies. Results: Our analysis included 16 studies involving 1403 patients. We found that various DOACs, including apixaban, dabigatran, and rivaroxaban, had rates of full recanalization, VTE recurrence, major hemorrhage, ICH, and mortality comparable to those of VKAs. VKAs showed the highest likelihood of full recanalization, with a P-score of 0.70, whereas apixaban had the lowest, with a P-score of 0.04. For reducing recurrent VTE rates, apixaban was the most effective (P-score = 0.83), and dabigatran the least (P-score = 0.04). Apixaban also led to the greatest reduction in ICH risk (P-score = 0.70), while rivaroxaban had the lowest likelihood (P-score = 0.29). Regarding major hemorrhage, apixaban had the highest probability of reduction (P-score = 0.81), with VKAs performing worst (P-score = 0.26). Lastly, apixaban ranked highest for reducing mortality (P-score = 0.78), whereas VKAs ranked lowest (P-score = 0.39). Conclusion: DOACs showed no significant differences in rates of full recanalization, VTE recurrence, major hemorrhage, ICH, or mortality compared with VKAs. Apixaban had the highest probability of reducing VTE recurrence, mortality, and hemorrhagic events, whereas VKAs had the highest probability of achieving full recanalization.
Keywords: cerebral venous thrombosis, direct oral anticoagulants, vitamin k antagonists, systematic review, network meta-analysis.
Full text available at:
DOI
Citation
Waseem MH, Abideen ZU, Rissardo JP, Khan MH, Farhan K, Fornari Caprara AL, Thada PK, Dmytriw AA. Comparing Efficacy and Safety of Different Anticoagulants in Cerebral Venous Thrombosis: A Systematic Review and Network Meta-Analysis. Clin Appl Thromb Hemost. 2026 Jan-Dec;32:10760296261427166. doi: 10.1177/10760296261427166.
Figure 1. PRISMA flowchart of the study selection process.
Figure 2. Forest plots (A) Full recanalization (B) Recurrent venous thromboembolism (C) Mortality (D) Major hemorrhage.
Figure 3. League table (A) Full recanalization (B) Recurrent venous thromboembolism (C) Mortality (D) Major hemorrhage.
Figure 5. Rankograms (A) Full recanalization (B) Recurrent venous thromboembolism (C) Mortality (D) Major hemorrhage.
Figure 6. Split node analysis (A) Full recanalization (B) Recurrent venous thromboembolism (C) Mortality (D) Major hemorrhage.
Table 1. Baseline Characteristics of the Included Studies.
Table 2. Treatment Ranking Based on P-Score.