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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 5  |  Page : 531-532

A case of post varicella cortical venous thrombosis successfully treated with dabigatran


Department of Neurology, St. John's Medical College Hospital, Bangalore, Karnataka, India

Date of Submission17-Jul-2013
Date of Decision17-Jul-2013
Date of Acceptance25-Aug-2013
Date of Web Publication22-Nov-2013

Correspondence Address:
Thomas Mathew
Department of Neurology, St. John's Medical College Hospital, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.121939

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How to cite this article:
Mathew T, Lobo AM, Kukkuta Sarma GR, Nadig R. A case of post varicella cortical venous thrombosis successfully treated with dabigatran. Neurol India 2013;61:531-2

How to cite this URL:
Mathew T, Lobo AM, Kukkuta Sarma GR, Nadig R. A case of post varicella cortical venous thrombosis successfully treated with dabigatran. Neurol India [serial online] 2013 [cited 2019 Sep 18];61:531-2. Available from: http://www.neurologyindia.com/text.asp?2013/61/5/531/121939


Sir,

Dabigatran is a novel reversible direct thrombin inhibitor and does not need monitoring. [1] It has been recently approved by the Food and Drug Administration for use in stroke prevention in nonvalvular atrial fibrillation [2],[3] and has been proven to be noninferior to warfarin in the prevention of recurrent venous thromboembolism in two recent double-blinded randomized controlled studies. [4] Here, we describe a patient with cortical venous sinus thrombosis, following varicella infection treated successfully with dabigatran.

A 33-year-old married lady with no previous comorbidities presented with vesiculopapular rash over the body and head of 10 days duration which has been diagnosed as varicella zoster infection and was treated with acyclovir. Six days later, she developed severe right hemicranial headache associated with vomiting. Clinical examination revealed bilateral papilledema. Magnetic resonance imaging and venography revealed thrombosis of right transverse, sigmoid, and straight sinuses without venous infarcts or hemorrhages. She had no history of recent pregnancy, abortions, or oral contraceptive use. There was no family history of thrombotic episodes. As she had extensive skin lesions over the body precluding the use of subcutaneous heparin and follow-up for coagulation monitoring was doubtful as she resided in a remote area, it was decided to use dabigatran for anticoagulation. After obtaining an informed consent, the patient was started on 150 mg twice a day of dabigatran along with antiedema measures. Patient reported relief of headache within 2 days of treatment and was discharged on the 4 th day of admission. She has followed-up with us with complete relief of headache and resolution of papilledema.

Dabigatran is finding favor among clinicians because its rapid onset of action and favorable safety profile. [1] It has a predictable anticoagulation effect that precludes frequent coagulation monitoring and has minimal food and drug interactions. Due to its rapid onset of action, it does not require bridging therapy with heparin and its analogues thereby cutting hospital stay and costs.

Current therapeutic options for cortical venous sinus thrombosis include dose-adjusted intravenous heparin or body weight adjusted subcutaneous low molecular weight heparin, followed by oral anticoagulation ranging from 3 months to lifelong anticoagulation depending on risk factors. If proven efficacious, dabigatran could substitute traditional oral and intravenous/subcutaneous anticoagulants as a treatment option for cortical venous sinus thrombosis, thereby bringing down the need of intravenous/subcutaneous therapy, cost of treatment, and cumbersome monitoring of coagulation parameters.

 
  References Top

1.Hankey GJ, Eikelboom JW. Dabigatran etexilate: A new oral thrombin inhibitor. Circulation 2011;123:1436-50.  Back to cited text no. 1
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2.Wann LS, Curtis AB, Ellenbogen KA, Estes NA 3 rd , Ezekowitz MD, Jackman WM, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on dabigatran): A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2011;123:1144-50.  Back to cited text no. 2
    
3.Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.  Back to cited text no. 3
[PUBMED]    
4.Schulman S, Kearon C, Kakkar AK, Schellong S, Eriksson H, Baanstra D, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709-18.  Back to cited text no. 4
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