ABSTRACT NUMBER: ESOC2026A1325 COMPARATIVE EFFECTIVENESS AND SAFETY OF FACTOR IIA VERSUS XA INHIBITORS IN THE TREATMENT OF CEREBRAL VENOUS THROMBOSIS: A DOAC-CVT SUBSTUDY

Abstract Background and aims DOACs are increasingly used to treat cerebral venous thrombosis (CVT), but comparative data between types of DOACs are limited. We compared dabigatran (factor IIa inhibitor) with factor Xa inhibitors regarding effectiveness and safety. Methods We used data from the DOAC-CVT study, which was an international, multicenter, prospective, observational cohort study, that compared the safety and effectiveness of DOACs versus vitamin K antagonists in adult patients with CVT. DOAC-treated patients were grouped as dabigatran and factor Xa inhibitor users, based on the first used DOAC. The primary outcome was a composite of major bleeding and recurrent venous thromboembolism at 12 months; secondary outcomes included favorable outcome (mRS:0-1), mortality, and bleeding (major plus clinically relevant non-major bleeding [ISTH criteria]). Binary logistic regression was applied. Results Of 619 included patients, 401 (64.8%) received a DOAC: 270 (67.3%) dabigatran and 131 (32.6%) a factor Xa inhibitor (65 apixaban, 60 rivaroxaban, 6 edoxaban). Dabigatran users were more frequently from high-income countries (72.9%vs54.2%). The primary outcome occurred in 12 (4.4%) dabigatran versus 2 (1.5%) factor Xa inhibitor users (aOR:3.28, 95%CI:0.70–15.48). Bleeding events were more frequent with dabigatran (15/270 [5.6%]) than factor Xa inhibitors (2/131 [1.5%]; aOR:4.80 [95%CI:1.00–23.04]). There was no difference in favorable outcome (80.7%vs80.0%, aOR:1.12, 95%CI:0.64–1.95) or mortality (0.7%vs3.0%, aOR:0.39, 95%CI:0.06–2.34). Conclusions Among DOAC-treated patients with CVT, use of dabigatran was possibly associated with more bleeding events than Factor Xa inhibitors. No difference in clinical outcome was found. Conflict of interest J.M.C. received funding from the Netherlands Thrombosis Foundation, grants from Bayer and AstraZeneca, and is co-founder and shareholder of TrianecT. K.J. has received academic grants from the Swedish state under the agreement between the Swedish government and the country councils, academic grants from the Swedish Stroke Association, and consulting fees from Janssen. All other author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract.