Venous Thrombotic Recurrence After Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is an uncommon disease that mainly affects subjects younger than 40 years of age, patients with thrombophilia, and women who are pregnant or receiving hormonal contraceptives. The annual incidence is estimated to be 3 to 4 cases per million, which increases to 12 cases per 100 000 deliveries during the peripartum period. Mortality and recurrence rates are lower when compared with arterial stroke, with an estimated annual risk of new venous thrombotic events after a first CVT at 2% to 3% for a new CVT and 3% to 8% for extracranial events. However, because of a paucity of prospective studies with long-term follow-up, recurrence of venous thrombosis (VT) after CVT is still largely unknown, as are predisposing factors for recurrence. In fact, mixed results exist on the factors associated with recurrence risk. In a multicenter observational study of 624 adult patients with CVT, male sex and polycythemia/thrombocythemia were found to be the only independent predictors of venous thromboembolism after CVT. These results were not confirmed by other authors who observed an association between recurrence and a history of previous extracerebral venous thrombotic events, whereas in another study no variable was found to be significantly associated with recurrent VT. No study to date has estimated risk of VT recurrence with different CVT causes. We, therefore, aimed to prospectively evaluate the incidence of recurrent cerebral and extracerebral venous thrombotic events in a cohort of CVT patients and to detect clinical, biological, and radiological factors associated with VT recurrence.