Clinical characteristics and risk factor analysis of 118 patients with cerebral venous sinus thrombosis

doi:10.16150/j.1671-2870.2023.03.09

Abstract

Abstract:

Objective: To analyze the clinical characteristics and thrombotic risk factors of cerebral venous sinus thrombosis (CVST) in Chinese population, in order to provide reference for the clinical diagnosis, prevention and treatment of CVST. Methods: A total of 118 CVST patients who visited the Thrombosis and Hemostasis Clinic of Ruijin Hospital from January in 2015 to December in 2022 were enrolled. The clinical data, imaging characteristics, and thrombotic gene panel were collected, and independent risk factors for thrombosis, recurrence, and multi-site thrombosis in CVST patients were studied through univariate and multivariate logistic regression. Results: Among 118 CVST patients, 88.1% (104/118) patients firstly developed CVST at age younger than 45 years old.It revealed that 57.6% patients (68/118) only suffered CVST once,and 33.1% patients (39/118) experienced thrombotic events at least twice, while 37.3% patients (44/118) suffered multi-site venous thromboembolism (VTE). The superior sagittal sinus was the most common venous sinus to form thrombosis (77/118), and multi-sites of venous sinus were involved simultaneously in 54.2% patients (64/118). The risk factor screening for thrombophilia showed that 70.3% patients (83/118) carried at least one thrombotic risk factor, including 53.3% patients (63/118) with inherited risk factors and 32.2% patients (38/118) with acquired risk factors. The main risk factors for males were anticoagulant protein deficiency (35/66) and antiphospholipid syndrome (5/66), while the risk factors for females mainly included anticoagulant protein deficiency (20/52), pregnancy/postpartum period (11/47), and contraceptive use (5/47). Among 35 patients with unknown risk factors, more than 30% of them experienced recurrent or multi-site thrombosis, and the underlying etiology in these patients still need to be further investigated. Univariate and multivariate logistic regression analysis showed that both inherited risk factors (odds ratio, OR=21.643, 95% confidence interval， CI 9.455-49.544, P<0.0001) and acquired risk factors (OR=10.836, 95% CI 4.306-27.270, P<0.0001) were independent risk factors for the occurrence of CVST. Genetic risk factor (OR=2.270, 95% CI 1.021-5.048, P=0.044) was an independent risk factor for recurrent thrombosis in CVST patients. Conclusions: In Chinese population, CVST is more common in middle-aged and young populations.，with 70.3% patients carrying at least one thrombotic risk factor. Genetic risk factors are the main cause of CVST in China and the detectable rate is 53.3%, which is significantly higher than that (22%) reported abroad. The patients with genetic risk factors have a significantly increased risk of developing CVST or recurrent thrombosis. Identification of thrombotic risk factors, prevention, diagnosis and treatment should be carried out earlier for individuals with high-risk CVST.

Key words: Cerebral venous sinus thrombosis, Clinical features, Genetic risk factors, Acquired risk factors

CLC Number:

R743.32

LI Lei, WU Xi, DAI Jing, WU Wenman, DING Qiulan, WANG Xuefeng. Clinical characteristics and risk factor analysis of 118 patients with cerebral venous sinus thrombosis[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 261-269.

Figures/Tables 5

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Parameter	CVST patients (N=118)	Controls (N=149)	P value
Age（y）
Age at first referral to the center	34.42±11.75	32.89±7.42	0.195 9
Age at first onset of CVST	32.59±12.06	NA	-
Gender
Male	66 (55.9%)	82 (55.0%)	0.883 4
Female	52 (44.1%)	67 (45.0%)
VTE occurrences
1	79 (66.9%)	NA	-
≥2	39 (33.1%)	NA	-
History of VTE
CVST	74 (62.7%)	NA	-
CVST+DVT/PE/PVT	44 (37.3%)	NA	-
Occluded sinus/vein
Superior sagittal sinus	77 (65.3%)	NA	-
Transverse sinus	70 (60.0%)	NA	-
Sigmoid sinus	50 (42.3%)	NA	-
Straight sinus	7 (5.9%)	NA	-

Parameter	CVST patients (N=118)	Controls (N=149)	P value
Genetic risk factors	63 (53.4)	8 (5.4)	<0.000 1
AT deficiency	12 (10.2)	0	-
PC deficiency	22 (18.6)	6 (4.0)	0.000 1
PS deficiency	16 (13.6)	1 (0.7)	<0.000 1
PS&PC deficiency	3 (2.5)	0	-
AT&PC deficiency	2 (1.7)	0	-
Other thrombotic mutations	8 (6.8)	1 (0.7)	0.016 2
Acquired risk factors	38 (32.2)	7 (4.7)	<0.000 1
Pregnancy/puerperium ^b)	11 (24.4)	1 (1.5)	0.000 5
Oral contraceptive use^b)	5 (11.1)	3 (4.5)	0.347 5
Antiphospholipid syndrome	6 (5.1)	0	-
Thrombocytosis	5 (4.2)	0	-
Major surgery	4 (3.4)	0	-
Malignancy	1 (0.8)	0	-
Systemic lupus erythematosus	1 (0.8)	0	-
Hyperthyroidism	1 (0.8)	0	-
Anemia	1 (0.8)	1 (0.7)	0.583 2
Hyperhomocysteinemia	1 (0.8)	1 (0.7)	0.583 2
Intracranial hypotension	1 (0.8)	0	-
Long-range flight	1 (0.8)	0	-
Immobilization	1 (0.8)	1 (0.7)	0.583 2
None identified	35 (29.7)	135 (90.6)	<0.000 1

Parameter	Only with genetic VTE risk factors (group 1)	Only with acquired VTE risk factors (group 2)	With both genetic and acquired VTE risk factors (group 3)	Without significant VTE risk factors (group 4)
Number (%)	45 (38.1)	20 (16.9)	18 (15.3)	35 (29.7)
First-onset age of CVST	32.53±13.02	34.75±10.65	30.11±8.76	32.71±12.56
Gender
Male	31 (68.9)	4 (20.0)	6 (33.3)	25 (71.4)
Female	14 (31.1)	16 (80.0)	12 (66.7)	10 (28.6)
Number of VTE occurrences
1	28 (62.2)	18 (90.0)	9 (50.0)	24 (68.6)
≥2	17 (37.8)	2 (10.0)	9 (50.0)	11 (31.4)
Location of VTE
CVST	28 (62.2)	15 (75.0)	10 (55.6)	23 (65.7)
CVST+DVT/PE/PVT	17 (37.8)	5 (25.0)	8 (44.4)	12 (34.3)
Occluded sinus/vein
Superior sagittal sinus	31 (68.8)	10 (50.0)	12 (66.7)	24 (68.6)
Transverse sinus	27 (60.0)	10 (50.0)	12 (66.7)	21 (60.0)
Sigmoid sinus	23 (51.1)	8 (40.0)	7 (38.9)	12 (34.3)
Straight sinus	2 (4.4)	1 (5.0)	1 (5.6)	3 (8.6)
VTE history
Positive	14 (31.1)	1 (5.0)	4 (22.2)	2 (5.7)
Negative	31 (68.9)	19 (95.0)	14 (77.8)	33 (94.3)

Variants	Univariate analysis		Multivariate analysis
Variants	Adjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Age^a)	0.997 (0.972-1.022)	0.807 0	0.994 (0.962-1.027)	0.706 0
Gender
Male vs. Female	1.037 (0.638-1.686)	0.883 0	1.456 (0.756-2.804)	0.261 0
With genetic risk factors
Yes vs. No	20.189 (9.081-44.881)	<0.000 1	21.643 (9.455-49.544)	<0.000 1
With acquired risk factors
Yes vs. No	9.636 (4.113-22.577)	<0.000 1	10.836 (4.306-27.270)	<0.000 1

Variants	Recurrent VTE		Multi-site VTE
Variants	Adjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Univariate analysis
Onset age of CVST	0.986 (0.954-1.019)	0.388	1.013 (0.982-1.045)	0.412
Gender
Male vs. Female	2.158 (0.971-4.797)	0.059	1.588 (0.744-3.392)	0.232
With genetic risk factors
Yes vs. No	2.270 (1.021-5.048)	0.044	1.676 (0.785-3.581)	0.182
With acquired risk factors
Yes vs. No	0.757 (0.327-1.749)	0.514	1.147 (0.518-2.538)	0.735
Family history of VTE
Yes vs. No	1.016 (0.373-2.764)	0.976	0.621 (0.222-1.741)	0.365
Multivariate analysis
Onset age of CVST	0.991 (0.958-1.025)	0.595	1.017 (0.986-1.050)	0.285
Gender
Male vs. Female	2.166 (0.961-4.883)	0.062	1.613 (0.745-3.493)	0.225
With genetic risk factors
Yes vs. No	2.278 (1.012-5.129)	0.047	1.676 (0.785-3.581)	0.182
With acquired risk factors
Yes vs. No	1.087 (0.423-2.797)	0.862	1.555 (0.630-3.841)	0.338
Family history of VTE
Yes vs. No	0.693 (0.235-2.043)	0.507	0.474 (0.160-1.402)	0.177