Batroxobin in combination with anticoagulation may promote venous sinus recanalization in cerebral venous thrombosis: A real-world experience

Jia-Yue Ding, Li-Qun Pan, Yan-Yu Hu, Gary B Rajah, Da Zhou, Chao-Bo Bai, Jing-Yuan Ya, Zhong-Ao Wang, Ke-Xin Jin, Jing-Wei Guan, Yu-Chuan Ding, Xun-Ming Ji, Ran Meng, Jia-Yue Ding, Li-Qun Pan, Yan-Yu Hu, Gary B Rajah, Da Zhou, Chao-Bo Bai, Jing-Yuan Ya, Zhong-Ao Wang, Ke-Xin Jin, Jing-Wei Guan, Yu-Chuan Ding, Xun-Ming Ji, Ran Meng

Abstract

Aims: The objective of this study was to evaluate cerebral venous recanalization with magnetic resonance black-blood thrombus imaging (MRBTI) in patients with cerebral venous thrombosis (CVT) who underwent batroxobin treatment in combination with anticoagulation.

Methods: A total of 31 CVT patients were enrolled in this real-world registry study. The patients were divided into batroxobin (n = 21) and control groups (n = 10). In addition to the same standard anticoagulation as in the control group, patients in the batroxobin group underwent intravenous batroxobin for a total of three times.

Results: In the batroxobin group compared with the control group, we found better odds of recanalization degree [adjusted OR (95%CI) of 8.10 (1.61-40.7)] and segment-stenosis attenuation [adjusted OR (95%CI) of 4.48 (1.69-11.9)] with batroxobin treatment. We further noted a higher ratio of patients with the attenuation of stenosis [adjusted OR (95%CI) of 26.4 (1.10-635)]; as well as a higher ratio of segments with stenosis reversion [adjusted OR (95%CI) of 4.52 (1.48-13.8)]. However, neurological deficits between the two groups showed no statistical difference at 90-day follow-up (P > 0.05).

Conclusions: Batroxobin may promote venous sinus recanalization and attenuate CVT-induced stenosis. Further randomized study of this promising drug may be warranted to better delineate the amount of benefit.

Keywords: anticoagulation; batroxobin; cerebral venous thrombosis; defibrinogenating effect.

Conflict of interest statement

All authors report no conflicts of interest.

© 2018 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
On MRBTI maps (follow‐up vs. baseline), the degree of the segment‐stenosis attenuation consists of: A, Class 0: exacerbation (thrombus increased); B, Class 1: no change or mild recovery (thrombus no change or reduced

Figure 2

Batroxobin group vs. control: The…

Figure 2

Batroxobin group vs. control: The raw distribution of (A) the follow‐up recanalization; (B)…

Figure 2
Batroxobin group vs. control: The raw distribution of (A) the follow‐up recanalization; (B) the segment‐stenosis extent attenuation

Figure 3

The pattern diagram of coagulation‐fibrinolysis…

Figure 3

The pattern diagram of coagulation‐fibrinolysis pathways: Anticoagulation such as LWMH mainly inhibits coagulation…

Figure 3
The pattern diagram of coagulation‐fibrinolysis pathways: Anticoagulation such as LWMH mainly inhibits coagulation pathway; tPA dissolves the thrombus in venous sinus, which acts on fibrinolysis pathway; endovascular treatment removes the thrombus directly; Batroxobin shares a combinatory effect of anticoagulation and fibrinolysis. The brief diagram is shown in the upper right with a purple frame
Figure 2
Figure 2
Batroxobin group vs. control: The raw distribution of (A) the follow‐up recanalization; (B) the segment‐stenosis extent attenuation
Figure 3
Figure 3
The pattern diagram of coagulation‐fibrinolysis pathways: Anticoagulation such as LWMH mainly inhibits coagulation pathway; tPA dissolves the thrombus in venous sinus, which acts on fibrinolysis pathway; endovascular treatment removes the thrombus directly; Batroxobin shares a combinatory effect of anticoagulation and fibrinolysis. The brief diagram is shown in the upper right with a purple frame

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