SECRET trial: rivaroxaban for cerebral venous thrombosis

Описание: Thalia Field, MD, FRCPC, MHSc, University of British Columbia in Vancouver, Canada, shares the compelling findings of the Phase II SECRET trial (NCT03178864) presented at the ESOC 2023 conference. The primary objective of the SECRET trial was to address the existing uncertainties surrounding cerebral venous thrombosis (CVT) management by comparing the safety and efficacy of rivaroxaban to the standard treatment of warfarin or low molecular-weight heparin for 180 days. Despite direct oral anticoagulants (DOACs) demonstrating safety and efficacy in other types of venous thromboembolism, there was hesitance in their adoption for CVT due to the lack of specific evidence and concerns regarding intracranial hemorrhage. Dr. Field and her team designed the SECRET trial as a pilot safety study to assess the safety and potential benefits of DOACs, as well investigating the feasibility of recruitment in this patient population. The trial also aimed to identify alternative meaningful endpoints for future CVT studies, as conventional endpoints may not capture the nuances of this rare disease. During the course of the trial, over 50 patients were successfully recruited from multiple sites across Canada. Bleeding rates were numerically higher in the rivaroxaban arm compared to standard of care, but rates were low overall. The trial also explored secondary outcomes such as functional independence, quality of life, mood, fatigue, and cognitive performance, which were all markedly improved by day 180. The SECRET trial has yielded valuable insights for the future management of CVT and holds the potential to influence upcoming guideline updates.

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