Direct oral anticoagulants in the treatment of cerebral venous sinus thrombosis: a single institution's experience.

AIM OF THE STUDY: Oral anticoagulants, preferentially vitamin K antagonists (VKA), are recommended for 3-12 months in patients with cerebral venous sinus thrombosis (CVST). We present a series of patients with CVST treated with direct oral anticoagulants (DOAC). MATERIALS AND METHODS: We prospectively recruited 36 patients with CVST (aged 40.3 ± 9.2 years, 58.3% female) treated with DOAC based on the physician's or patient's preferences. Functional outcome was assessed with modified Rankin Scale. Recanalisation was assessed on imaging at 3-6 months post the event. Patients were followed for a median of 30 [interquartile range (IQR) 25-37] months. RESULTS: After use of heparin (median: 6 days; IQR 5-8.75), patients received dabigatran (150 mg bid, n = 16 or 110 mg bid, n = 2), rivaroxaban (20 mg qd, n = 10) or apixaban (5 mg bid, n = 8) for a median of 8.5 months (IQR 6.25-12). Complete or partial recanalisation was observed in 34 cases (94.4%). Three patients (8.3%) experienced major bleeding: menorrhagia on rivaroxaban (n = 2) and gastrointestinal bleeding on dabigatran (n = 1). A favourable functional outcome was observed in 24 (66.7%) patients, without any fatality. CSVT recurred in two patients (5.6%) and two venous thromboses developed in two other patients with inherited thrombophilia after anticoagulation withdrawal. CONCLUSIONS AND CLINICAL IMPLICATIONS: DOACs could be an alternative to VKA in CVST patients.

False-positive lupus anticoagulant in patients receiving rivaroxaban: 24 h since the last dose are needed to exclude antiphospholipid syndrome.

Rivaroxaban, a direct factor Xa inhibitor, affects laboratory clotting tests. We report here 10 venous thromboembolism patients with false-positive lupus anticoagulant during rivaroxaban therapy. Two dilute Russell Viper Venom time (dRVVT)-based integrated assays, HemosIL dRVVT Screen/HemosIL dRVVT Confirm (Instrumentation Laboratory, LA1/LA2 (Siemens, Germany) and LA1/LA2 (Siemens, Marburg, Germany), showed that the patients were lupus anticoagulant-positive. Antiphospholipid antibodies were negative except for one patient. Screening activated partial thromboplastin time-based assay PTT lupus anticoagulant was lupus anticoagulant-positive, whereas the confirmatory Staclot lupus anticoagulant (both Diagnostica Stago, France) was lupus anticoagulant-negative. Re-examination after discontinuation of rivaroxaban (>24 h) ruled out the presence of lupus anticoagulant. Our data indicate that to reliably evaluate lupus anticoagulant in patients on rivaroxaban, blood should be drawn 24 h after the last dose.

Quantification of airborne birch (Betula sp.) pollen grains and allergens in Krakow.

INTRODUCTION: Birch (Betula sp.) pollen grains are the main cause of seasonal allergies in northern and central Europe. The allergen particles released from the grains are often well distributed in the air. Due to their size, airborne protein particles can easily penetrate into the lower parts of the respiratory airways and may lead to symptoms of asthma. The purpose of this paper was to quantify both Betula sp. pollen grains and allergens in the air. MATERIAL/METHODS: Materials for the investigation were collected in the spring of 2003 with two Hirst-type pollen volumetric traps. Tapes from one trap served for routine birch pollen grain counts, while those from the second for the immunodetection of birch allergens. As birch pollen allergen concentration is seen as dark spots on X-ray films densitometric measurements of the spots were used to quantify birch-pollen antigen concentrations in the air. RESULTS: In most instances, birch pollen counts corresponded with birch pollen allergen levels. However, on several occasions outside the pollen season, only grains or only allergens were detected. Apart from sampling variability, this could be due to faulty/dead pollen grains or submicronic airborne allergen particles. CONCLUSIONS: Counting intact pollen grains and antibody-based detection of allergen molecules are efficient tools in controlled allergen avoidance.