Title: Direct Oral Anticoagulants versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-analysis (P7-4.010)
Authors: Zain ul Abideen, Hassan Waseem, Areeba Shoaib, Nohela Rehman, Muhammad Osama, Barka Sajid, Muhammad Mukhlis, Muhammad Ansari, Muhammad Ansari, Rowaid Ahmad, Justin Chen, Jamir Pitton Rissardo, Ana Leticia Fornari Caprara, Vishnu Byroju, Adam Dmytriw, and Brandon Lucke-Wold
Conference: 2026 AAN, Chicago, IL
Objective
This meta-analysis aims to compare the effectiveness and safety of direct oral anticoagulants (DOACs) with those of vitamin K antagonists (VKAs) in treating cerebral venous thrombosis (CVT).
Background
CVT is a rare cause of stroke, mainly affecting young people. The standard treatment plan includes anticoagulation with low molecular weight heparin (LMWH) and then VKAs. While DOACs show promise, their effectiveness and safety are still uncertain.
Design/Methods
Electronic databases, including PubMed, Cochrane Library, and ScienceDirect, were searched from the inception to April 2025. We pooled risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model in Review Manager 5.4.1. To assess quality, we used the Cochrane risk of bias (RoB 2.0) tool and the Newcastle-Ottawa Scale (NOS). We also conducted subgroup analyses based on study design and different types of DOACs.
Results
Thirty-one studies, comprising 5 randomized controlled trials (RCTs) and 26 observational studies, were included in this meta-analysis. Our analysis revealed a significant decrease in the risk of recurrent venous thromboembolism (VTE) in the DOACs group compared to VKA (RR= 0.84; 95%CI: [0.71,0.99]; p=0.04; I2=0%). Likewise, DOACs showed a significant advantage over VKA in terms of intracranial hemorrhage (ICH) (RR= 0.67; 95%CI: [0.50,0.89]; p=0.007; I2=0%). Other outcomes, including major hemorrhage (RR= 0.70; 95%CI:[0.42,1.15]; p=0.16; I2=0%), all-cause mortality (RR= 0.96; 95%CI:[0.68,1.35]; p= 0.81; I2=0%), and full recanalization (RR= 0.92; 95%CI:[0.82,1.03]; p= 0.16; I2=21%), were comparable between the two groups.
Conclusions
DOACs showed a significant reduction in the risk of recurrent VTE and ICH compared to VKAs, whereas major hemorrhage, all-cause mortality, and full recanalization were comparable.
Citation
ul Abideen Z, Waseem H, Shoaib A, Rehman N, Osama M, Sajid B, Mukhlis M, Ansari M, Ansari M, Ahmad R, Chen J, Rissardo JP, Caprara AL, Byroju V, Dmytriw A, Lucke-Wold B. Direct Oral Anticoagulants versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-analysis (P7-4.010). Neurology 2026;106(11_suppl_1):565. doi: 10.1212/WNL.0000000000212992.
Figure 1. Forest plot of recurrent VTE shows DOACs reduce risk versus VKAs in CVT, with consistent effects across studies and low heterogeneity.