Comparing Efficacy and Safety of Different Anticoagulants in Cerebral Venous Thrombosis: A Systematic Review and Network Meta-Analysis

BackgroundCerebral venous thrombosis (CVT) is a rare but severe type of stroke, typically treated with vitamin K antagonists (VKAs). This study compares different direct oral anticoagulants (DOACs) with VKAs for the management of CVT.MethodsPubMed, Cochrane Central, and ScienceDirect were searched up to May 2025. A network meta-analysis using a frequentist approach was performed in RStudio version 4.3.3. P-scores were used to rank treatments. The evaluated outcomes included full recanalization, recurrent venous thromboembolism (VTE), major hemorrhage, intracranial hemorrhage (ICH), and mortality. The Cochrane Risk of Bias (RoB 2.0) tool and the Newcastle-Ottawa Scale (NOS) were employed to assess the quality of randomized controlled trials (RCTs) and observational studies.ResultsOur analysis included 16 studies involving 1403 patients. We found that various DOACs, including apixaban, dabigatran, and rivaroxaban, had rates of full recanalization, VTE recurrence, major hemorrhage, ICH, and mortality comparable to those of VKAs. VKAs showed the highest likelihood of full recanalization, with a P-score of 0.70, whereas apixaban had the lowest, with a P-score of 0.04. For reducing recurrent VTE rates, apixaban was the most effective (P-score = 0.83), and dabigatran the least (P-score = 0.04). Apixaban also led to the greatest reduction in ICH risk (P-score = 0.70), while rivaroxaban had the lowest likelihood (P-score = 0.29). Regarding major hemorrhage, apixaban had the highest probability of reduction (P-score = 0.81), with VKAs performing worst (P-score = 0.26). Lastly, apixaban ranked highest for reducing mortality (P-score = 0.78), whereas VKAs ranked lowest (P-score = 0.39).ConclusionDOACs showed no significant differences in rates of full recanalization, VTE recurrence, major hemorrhage, ICH, or mortality compared with VKAs. Apixaban had the highest probability of reducing VTE recurrence, mortality, and hemorrhagic events, whereas VKAs had the highest probability of achieving full recanalization.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Ensayos clínicos.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Wound healing potential of bark paste of Pongamia pinnata along with hirudotherapy: A case report — Balasooriya D, Karunarathna C, Uluwaduge I (2021)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• Study on the effect of medicinal leech therapy (Hirudo medicinalis) on full-thickness excisional wound healing in the animal model — Zakian A et al. (2022)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis — Aminov R, Frolov A, Aminova A (2022)
• Recombinant hirudin in clinical practice: focus on lepirudin — Greinacher A, Lubenow N (2001)

Browse all ASH-analysed research →