Late Complications Common After CVT, Even After Recovery

TOPLINE: After experiencing cerebral venous sinus thrombosis (CVT), more than 90% of patients achieved functional independence within 2 years, new research showed. However, one third developed delayed complications such as seizures, headaches, or bleeding. METHODOLOGY: - An ambispective (combining retrospective and prospective data) cohort study used data from the Vellore CVT Registry in India of nearly 2500 adult patients with CVT (median age, 34 years; 53% women) enrolled between 2000 and 2024. - Overall, 96% of patients survived the acute phase and were followed for a mean of 3.2 years. 70% completed 1-year follow-up and 26% were followed for more than 5 years. - Participants received acute treatment with low-molecular-weight heparin (74%) or unfractionated heparin (25%), followed by long-term therapy with oral anticoagulants (OACs, 82%) or novel OACs (7%). - Outcome measures included functional status assessed using the modified Rankin Scale (mRS), mortality, and long-term complications such as seizures, headaches, bleeding events, recurrent CVT, thrombotic events, malignancies, dural arteriovenous fistulas (DAVFs), or adverse pregnancy-related outcomes. TAKEAWAY: - Favorable functional outcomes (mRS ≤ 2) were achieved by 92% of patients within 2 years. During follow-up, 2% of patients died, with 58.5% of deaths occurring within the first year and 24% within the first 3 months. Mortality increased among those who required ICU treatment (hazard ratio, 1.2; P < .001). - Complications occurred in 33.5% of patients, with 51% requiring rehospitalization; 55% of complications occurred more than 2 years after the initial CVT diagnosis. The most frequent complications were seizures (10% of patients), with neuroimaging evidence of midline shift (odds ratio [OR], 2.55; P < .001), herniation (OR, 2.5; P < .001), focal seizures (OR, 1.6; P = .003), and generalized seizures (OR, 2.1; P < .001) identified as risk factors. - New-onset headache was reported in 8% of patients. Bleeding complications occurred in 4%, with 84% of events occurring during anticoagulation therapy. Having baseline anemia, using oral contraceptive pills (OCPs), or being a woman were strong predictors of increased risk for bleeding (P < .001 for all). - Recurrent CVT developed in 1% of patients after a mean interval of 64 months, and use of OCPs was linked to a 2.7-fold increased risk for recurrence (P = .02). Twenty-four patients (1%) developed malignancies at a median of 50 months, with 79% of these patients diagnosed more than 1 year after CVT, and DAVFs developed in 1%. Among women with subsequent pregnancies, 3% experienced thrombotic events. IN PRACTICE: “While CVT often has a favorable prognosis, long-term follow-up reveals a significant burden of late complications. Crucially, these findings argue against a limited follow-up period, demonstrating the necessity for structured long-term surveillance in CVT survivors,” the investigators wrote. SOURCE: The study was led by Sanjith Aaron, MD, Christian Medical College, Vellore. It was published online on February 17 in the International Journal of Stroke. LIMITATIONS: The findings were not fully generalizable to other settings with different referral patterns or healthcare resources. The follow-up duration was variable, with attrition over time, potentially leading to an underestimation of late complications. The ambispective design introduced potential biases related to changes in diagnostic practices, imaging availability, and treatment strategies over the long study period. Some outcomes, particularly headaches and seizures, may have been subject to recall or reporting bias. Bleeding events were not classified using the International Society on Thrombosis and Hemostasis criteria. The study was conducted in a tertiary care referral center, which may have led to underestimating milder presentations. DISCLOSURES: No specific funding was obtained for the study. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.