PDF: VENOST
(2017)Objective
To characterize the clinical, radiological, and etiological features of cerebral venous thrombosis in a large cohort of Caucasian patients from Turkey.
Study Summary
Intervention
Observational registry including patients diagnosed with CVT via imaging across 35 Turkish centers between 2000 and 2015. Treatment was per physician discretion and included anticoagulation.
Inclusion Criteria
Patients aged ≥18 years with radiologically confirmed CVT and available follow-up data. Diagnosis confirmed via MRI/MRV, CT/CTV, or DSA.
Study Design
Arms: Single Arm: Observational Cohort
Patients per Arm: 1144
Outcome
Bottom Line
The VENOST study, a large multicenter observational study of Caucasian CVT patients, found clinical and radiological features consistent with previous studies, but identified different predisposing factors, notably a higher incidence of puerperium and lower oral contraceptive use. Malignancy, older age, and hemorrhagic infarcts were associated with worse outcomes, while epileptic seizures had no negative impact.
Major Points
- The study included 1144 patients with confirmed CVT from 35 national stroke centers in Turkey, with data collected retrospectively (2000-2013) and prospectively (after 2013).
- 67.9% of patients were women, but male patients were more prevalent in the older age group (>50 years) (27.8% vs 16.6% in women; P<.001).
- The most frequent symptoms were headache (87.2%), nausea and vomiting (27.7%), visual field defects (26.5%), and epileptic seizures (23.7%). Headache was the sole symptom in 25.1% of patients.
- Gynecological factors (puerperium 18.3%, oral contraceptive use 13.9%, pregnancy 9.5%) comprised the largest etiological group in women. Oral contraceptive use was not a prevalent risk factor in this cohort.
- Prothrombotic conditions (26.4%), mainly MTHFR mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders.
- Infection-associated etiology was found in 8.1% of patients and malignancy-related in 5.2%; both were significantly higher in men and older age groups (P<.001).
- Parenchymal involvement (constitutively hemorrhagic infarcts), malignancy, and older age were associated with higher modified Rankin Scale (mRS) scores (worse outcome).
- Epileptic seizures had no effect on prognosis. Patients with focal neurological deficit and altered consciousness had unfavorable prognosis.
- Most patients were anticoagulated (83.9%) in the early period with intravenous heparin (69.6%) or subcutaneous low-molecular weight heparin (14.3%).
- At 1-month follow-up, 78.4% of patients had mRS 0-1, 11.7% had mRS 2, and 10.0% had mRS 3-5. No patients had mRS 6 due to CVT.
- Outcome was favorable in patients with no parenchymal lesions and worst in patients with hemorrhagic infarcts. Outcome was favorable in infectious-related CVT but unfavorable in malignancy.
Study Design
- Study Type
- National, multicenter, retrospective and prospective, hospital-based observational study
- Randomization
- No
- Sample Size
- 1144
- Follow-up
- Up to 12 months (follow-up visits recorded after 1, 3, 6, and 12 months if available).
- Centers
- 35
- Countries
- Turkey
Primary Outcome
Definition: Functional outcome at 3 months (mRS 0–1) in Caucasian patients with cerebral venous thrombosis, with description of clinical, radiological, and etiological features.
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| - | - | - | - |
Limitations & Criticisms
- The study has an observational nature, lacking uniform evaluation for etiology and treatment options, which may introduce bias.
- There were high dropout rates from long-term follow-up (e.g., 60.4% at 1 year).
- The study does not represent the entire CVST patient population, nor is it a random sample, which limits generalizability.
- Specific details on acute and maintenance treatment duration and dosages, beyond initial anticoagulation, are not uniformly provided for all patients.
- Information on acquired or congenital thrombophilic abnormalities was collected only if available, not uniformly.
- The study identified Behçet's disease as an underlying etiology more frequently than Western countries, but the impact of this specific etiology on overall outcomes is not fully explored.
- The authors mention that the proportion of women was higher in the older age group and acute onset was more common in younger ages, and chronic onset in older age, which could confound some age-related findings.
Citation
Journal of Stroke and Cerebrovascular Diseases, Vol.(), No.(), 2017: pp-. 10.1016/j.jstrokecerebrovasdis.2017.04.070