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ESOC 2023 | Key developments in CVT management: decompressive surgery and DOAC use

Diana Aguiar de Sousa, MD, PhD, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal, gives an overview of major developments in the treatment and management of cerebral venous thrombosis (CVT) that have emerged in recent years. Importantly, a prospective study of more than 100 patients confirmed data from retrospective studies indicating a benefit of decompressive surgery in patients with CVT. Decompressive surgery was often recommended in CVT patients with large lesions and impending brain herniation, based on retrospective data. The DECOMPRESS2 study provided strong evidence in support of these guidelines. Another development with direct implications for daily practice is the accumulation of evidence to support the use of direct oral anticoagulants (DOACs) in CVT. The RE-SPECT CVT trial, published in 2019, randomized 120 patients with CVT to dabigatran versus warfarin, showing no significant differences in efficacy and safety outcomes between the two treatment groups. More recently, the pilot SECRET trial suggested that rivaroxaban is a safe and effective option, while also identifying alternative, patient-oriented outcomes for future CVT studies, such as quality of life, mood, fatigue, and cognitive performance. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.

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Dr Aguiar de Sousa reported personal fees for AstraZeneca and Organon advisory board participation, travel support from Boehringer Ingelheim, DSMB participation for the SECRET trial (University of British Columbia), and speaking fees from Bayer and Bial.