Abstract 8: Outcomes And Recurrence Rates Among Patients With Provoked And Cryptogenic Cerebral Venous Thrombosis: Analysis Of The ACTION CVT Study

Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depend on the underlying etiology. This study aims to identify the characteristics and risk of recurrent venous thromboembolism (VTE) in patients with unprovoked CVT (cryptogenic), transient provoked CVT (peripartum, contraception, infection, trauma) and persistent provoked CVT (cancer, hereditary thrombophilias). Methods: We used the ACTION CVT retrospective database which included consecutive CVT patients in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. Baseline characteristics were compared between the groups using Chi square test, T test or Mann-Whitney-U test, followed by multivariable logistic regression. We used interaction analysis to assess the risk of recurrent venous thromboembolism (VTE). Results: A total of 1025 CVT patients were included in this study; 363 (35.4%) had transient provoking factors, 152 (14.8%) had persistent provoking factors, and 510 (49.8%) had cryptogenic CVT. Patients with transiently provoked CVT were younger (P=0.003) and more likely to be women (P<0.001), and patients with cryptogenic CVT were less likely to have a prior VTE (P<0.001). Compared to patients with transient provoked, there was higher risk of recurrent VTE in patients with persistent provoking factors (HR 2.59, 95% CI 1.29-5.22, P=0.008) and numerically higher recurrent VTE risk in cryptogenic CVT (HR 1.85, 95% CI 0.98-3.51, P=0.059). These associations did not vary by age, sex, or history of VTE status (p-interaction > 0.1 for all). Results were similar in sensitivity analyses excluding those with positive Factor V Leiden or Prothrombin gene mutation as well as in analyses excluding patients with positive antiphospholipid antibody test. Conclusions: In this multicenter study, we found that the risk of recurrent VTE after CVT may vary depending on the underlying etiology with higher rates in patients with cryptogenic CVT and those with persistent provoking factors. Longer anticoagulation duration may be needed in such groups compared to CVT with transient provoking factors.