Background

Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries.

Material and method

The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries.

Results

Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT – 68%) or Turkey (VENOST – 67%).

Conclusion

Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.

中文翻译：

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阿根廷脑静脉血栓形成：临床表现，诱发因素，结局和文献复习。

背景

脑静脉血栓形成（CVT）是一种罕见的医学疾病，主要影响年轻人。临床范围广泛，其识别仍然是临床医生面临的挑战。在阿根廷，有关CVT的信息有限。我们的目标是报告阿根廷第一个CVT国家注册中心的结果，并与其他国际注册中心比较临床表现，诱发因素和结果。

材料和方法

阿根廷国家CVT注册管理机构（ANR-CVT）是一项多中心回顾性队列研究，研究对象为2015年1月至2019年1月诊断为CVT的18岁及18岁以上患者。我们评估了人口统计学，诱发因素，临床表现和放射学特征（例如，入院时在CT和MRI扫描中涉及的鼻窦，静脉梗塞或出血的数量），出院时和90天时的治疗干预和功能结局。我们的结果与CVT注册表的文献综述进行了比较。

结果

总体而言，有162例患者符合纳入标准。平均年龄为42（±17）岁；妇女占72％。70％的患者年龄小于50岁。最常见的症状是头痛（82％）。横窦是最常见的血栓形成部位（70％），其次是乙状窦（46％）。女性的主要诱因是使用避孕药具（44％），其中3％的事件发生在怀孕期间和9％的产褥期间。50岁及以上的参与者发生恶性肿瘤的频率更高（7.5％vs. 30％，p = 0.0001）和感染（2％vs. 11％，p= 0.001）。出院时改良的Rankin量表（mRS）≤2为81％，出院时死亡率为4％。在90天时，mRS≤2为93％。当将ANR-CVT与来自欧洲和亚洲的大型注册机构进行比较时，CVT患者中的癌症患病率高出2到5倍（分别为15％，7％和3％；p = 0.002和p <0.001 ）。与来自亚洲（ASCVT – 68％）或土耳其（VENOST – 67％）的登记处相比，出院时的抗凝率也更高（94％）。

结论

第一次ANR-CVT的参与者在90天时死亡率和残疾率较低。临床和放射学特征与其他国际注册机构的CVT相似，其癌症患病率更高。出院时的抗凝率（范围为54.5％-100％）反映了治疗对指南的依从性存在很大差异。