Rivaroxaban is an oral anticoagulant that is increasingly used to treat systemic thrombosis. However, cerebral venous thrombosis (CVT) is conventionally treated with heparin followed by oral anticoagulants. This study looked at treating 20 patients with CVT directly with oral rivaroxaban without initial heparin therapy. The results found that 80% of patients were male with a mean age of 34.1 years. 95% of patients had an excellent clinical outcome and there was complete or partial recanalization in 60% and 40% of patients respectively at 3 month follow up. No complications from the rivaroxaban treatment were observed. The study concludes that rivaroxaban may be safely

1. CEREBRAL VEIN
THROMBOSIS

3. • IS IT SAFE TO TREAT CEREBRAL VENOUS THROMBOSIS WITH ORAL RIVAROXABAN WITHOUT HEPARIN? A
PRELIMINARY STUDY FROM 20 PATIENTS.
Shankar Iyer R1, Tcr R2, Akhtar S2, Muthukalathi K3, Kumar P3, Muthukumar K3.
Clin Neurol Neurosurg. 2018 Dec;175:108-111. doi: 10.1016/j.clineuro.2018.10.015. Epub 2018 Oct 31
• Abstract
• OBJECTIVES:
Newer oral anticoagulants like rivaroxaban are increasingly becoming the mainstay of treatment in systemic
thrombosis. However cerebral venous thrombosis (CVT) is conventionally treated with heparin followed by oral
vitamin K antagonists. Currently very little information is available about the use of rivaroxaban in CVT. Rivaroxaban
has been used only after the initial treatment with heparin in the available studies.
• PATIENTS & METHODS:
All patients with CVT between January 2017 and June 2017 were initiated directly on oral rivaroxaban. Critically ill
patients including those requiring surgical intervention were excluded. The modified Rankin scale was used to assess
clinical severity and a scale of 0-1 was defined as excellent outcome. Recanalization was assessed at 3 months
follow-up with MR angiography. Complications of the drug including bleeding episodes during treatment and at
follow-up were noted.
• RESULTS:
Twenty patients were initiated on rivaroxaban and followed up for a mean duration of 6 months. Eighty percent
(16/20) were males and the mean age was 34.1 years. Associated cerebral hemorrhagic infarcts were seen in
11(55%).Outcome was excellent in 19(95%). Complete recanalization was noted in 12(60%) and partial
recanalization in 8(40%). No complications emerged out of the drug use.
• CONCLUSIONS:
In clinically stable CVT rivaroxaban is safe and effective and may be used without previous heparin therapy. This
can shorten the duration of hospitalization thereby decreasing the costs of treatment.