Neurology · 1 h ago
DOACs Meet Noninferiority Criterion Versus Warfarin After Cerebral Venous Thrombosis
A registry-based target trial emulation of 2,476 adults with cerebral venous thrombosis in China compared initial DOAC treatment with warfarin. At one year, DOACs met the prespecified noninferiority criterion for symptomatic recurrent venous thromboembolism; bleeding events were too few for reliable comparative safety conclusions.
- 2,476 registry patients were included in the comparison.
- DOACs met the prespecified one-year noninferiority criterion.
- Bleeding events were too rare for comparative safety conclusions.
Vitamin K antagonists have traditionally been used for oral anticoagulation after cerebral venous thrombosis (CVT), but direct oral anticoagulants (DOACs) are increasingly prescribed. Researchers used a multicenter Chinese registry to emulate a target trial, including adults with imaging-confirmed CVT who started a DOAC or warfarin within 30 days of diagnosis. The retrospective and prospective registry phases covered 2015–2025. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) within one year. Propensity-score overlap weighting was used to adjust comparisons.
Among 2,476 patients, 942 started a DOAC and 1,534 warfarin. One-year symptomatic recurrent VTE occurred in 36 and 73 patients, respectively. Weighted recurrence risks were 3.74% with DOACs and 5.47% with warfarin, a risk difference of −1.73 percentage points (95% CI, −3.76 to 0.30). The subdistribution hazard ratio was 0.67 (95% CI, 0.37–1.21); the prespecified noninferiority criterion was met. Major bleeding was rare, occurring in zero DOAC-treated patients and one warfarin-treated patient.
The findings support further consideration of DOACs as an alternative to warfarin in this population, but the observational design leaves potential for residual confounding. Bleeding comparisons were exploratory and do not establish equivalent safety. The cohort was drawn from Chinese centers, which may limit generalizability.
In practice
For adults with imaging-confirmed cerebral venous thrombosis who are selected for oral anticoagulation, this registry-based target trial emulation found that initial DOAC treatment met the study’s prespecified noninferiority criterion versus warfarin for symptomatic recurrent VTE at one year. This is not randomized evidence: residual confounding may remain, and the Chinese multicenter cohort may not represent all populations. Major bleeding was very uncommon, so the study cannot establish comparative safety or bleeding equivalence; it does not by itself justify changing treatment practice.
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Stroke: Initial Direct Oral Anticoagulants Versus Warfarin After Cerebral Venous Thrombosis: A Target Trial Emulation ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.