Comparison of the efficacy of fixed-dose enoxaparin and adjusted-dose unfractionated heparin in patients with cerebral venous thrombosis

Objective: Anticoagulants are the standard treatment for cerebral venous thrombosis (CVT). Although low molecular-weight heparin (LMWH) is recommended in CVT, the specific type and dosage regimen of LMWH have never been specifically suggested. This study compared the clinical outcomes and adverse events in patients who received adjusted-dose unfractionated heparin (AD-UFH) versus fixed -dose enoxaparin (FD-E). Methods: A retrospective cohort study was conducted at a university hospital in Thailand. Patients included in the study were those treated for CVT initially with either AD-UFH or FD-E followed by oral warfarin for 1 year between January 2002 and December 2015. Electronic medical records were reviewed by the investigators. The baseline clinical characteristics, anticoagulant regimens, complications and outcomes at hospital discharge and 1-year follow-up were analyzed. Clinical outcomes (independency defined by modified Rankin score (mRS) 0-2 at hospital discharge and 1-year follow-up) and adverse events (gastrointestinal bleeding and intracranial hemorrhage) were compared between patients who received AD-UFH or FD-E. Results: Seventy-five patients met the inclusion criteria. Thirty-nine patients received AD-UFH and 36 patients received FD-E. The baseline demographic and clinical characteristics between the two groups were comparable. Independency at hospital discharge accounted for 51.28% in the AD-UFH group and 61.11% in the FD-E group (p = 0.392). There were no significant differences in the incidence of expansion of preexisting intracerebral hematoma (14.29% vs 18.18%; p = 0.773) or new symptomatic intracranial hemorrhage (7.69% vs 8.33%; p = 0.855). Independency at 1-year follow-up was also comparable between the two groups (71.78% vs 77.78%; p = 0.552). Conclusion: This current study suggested a comparable efficacy and safety of FD-E and AD-UFH in patients with CVT.