Patients affected by sinus thrombosis are treated with blood thinners. Traditionally, these patients are prescribed vitamin K antagonists (VKAs). In order to give the correct dosage, regular check-ups at the thrombosis service are necessary.

A global study, coordinated by Amsterdam UMC, now shows that new medication, direct oral anticoagulants (DOACs), are equally safe and effective. The study was published in The Lancet Neurology.

A big advantage is that this medication is more user-friendly because regular thrombosis monitoring is no longer necessary.

Neurologist and research leader Jonathan Coutinho said, "We think these new drugs will give patients a lot of ease of use. We also expect that it will lead to changes in the international standards for the treatment of these patients and that DOACs will probably become the standard for these patients in the future."

Sinus thrombosis is a rare and serious form of stroke that mainly affects people under the age of 50, with about 300 cases in the Netherlands every year, three-quarters of which are women. This condition causes a blockage in the blood vessels of the brain, which can lead to serious complications such as brain haemorrhages. The most common symptoms are excruciating headaches, paralysis symptoms and seizures.

Effectiveness and safety

In the largest international study of sinus thrombosis over the past 25 years, researchers from Amsterdam UMC compared the existing treatment with vitamin K antagonists (VKAs) with the new treatment with oral anticoagulants (DOACs). In total, data was collected from 619 patients from 23 countries across five continents. Of these 619 patients, 65% were treated with a DOAC and 35% with a VKA.

To assess the safety of the treatment, the researchers looked at the occurrence of major bleeding. This is the main side effect of blood thinners. Within six months of the diagnosis of sinus thrombosis, 3% of patients in both the DOAC and VKA groups experienced a new thrombosis or major bleeding. There is therefore no difference in effectiveness and safety between DOACs and VKAs.

"We are very happy that we were able to carry out this major study with our extensive international network. Especially after the introduction of the GDPR, these kinds of studies are very difficult to carry out in practice, but thanks to joint forces we succeeded," concludes Coutinho.

More information: Direct oral anticoagulants versus vitamin K antagonists for cerebral venous thrombosis (DOAC-CVT): an international, prospective, observational cohort study, The Lancet Neurology (2025).