Apixaban Use in the Management of Cerebral Venous Sinus Thrombosis: Two Cases with Warfarin Resistance and Labile INR

Öz

Background: Cerebral venous sinus thrombosis (CVST) treatment primarily relies on effective anticoagulation; following the acute phase, the standard option during the maintenance period is typically vitamin K antagonists (VKA). However, warfarin resistance or a labile international normalized ratio (INR) course are critical barriers that limit an effective treatment process. In this report, two CVST cases where therapeutic targets could not be reached with standard anticoagulant therapy and the experience with apixaban use are presented.

Case Presentation: With apixaban (5 mg bid) treatment, complete clinical recovery was achieved in both patients, and total recanalization was detected on magnetic resonance venography (MRV). No recurrent thrombosis or bleeding complications developed during the follow-up period. These cases support that apixaban is an effective and safe alternative in selected CVST cases.

Conclusion: Thanks to its predictable pharmacokinetic advantages, apixaban may increase patient compliance and clinical success by eliminating the requirement for routine monitoring.

Anahtar Kelimeler

• Cerebral venous sinus thrombosis
• apixaban
• warfarin resistance
• labile INR
• anticoagulation

Serebral Venöz Sinüs Trombozu Yönetiminde Apiksaban Kullanımı: Varfarin Direnci ve Labil INR İzlenen İki Olgu

Öz

Arka Plan: Serebral venöz sinüs trombozu (SVST) tedavisinde temel strateji etkin antikoagülasyondur; akut fazı takiben idame dönemindeki standart seçenek genellikle vitamin K antagonistleridir (VKA). Ancak varfarin direnci veya labil uluslararası düzeltilmiş oran (INR) seyri, etkin tedavi sürecini kısıtlayan kritik engellerdir. Bu sunumda; standart antikoagülan tedavi ile terapötik hedeflere ulaşılamayan iki SVST olgusu ve apiksaban kullanım deneyimi sunulmuştur.

Olgu Sunumu: Apiksaban (5 mg 2x1) tedavisiyle her iki hastada tam klinik iyileşme sağlanmış ve manyetik rezonans venografide (MRV) tam rekanalizasyon saptanmıştır. İzlem sürecinde nüks tromboz veya kanama komplikasyonu gelişmemiştir. Bu olgular, seçilmiş SVST vakalarında apiksabanın etkili ve güvenli bir alternatif olduğunu desteklemektedir.

Sonuç: Apiksaban, öngörülebilir farmakokinetik avantajları sayesinde rutin izlem gereksinimini ortadan kaldırarak hasta uyumunu ve klinik başarıyı artırabilir.

Anahtar Kelimeler

• Serebral venöz sinüs trombozu
• apiksaban
• varfarin direnci
• labil INR
• antikoagülasyon

Kaynakça

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