Introduction Cerebral venous thrombosis (CVT) often presents with favorable short‐term outcomes. However, risk factors predisposing an individual to CVT recurrence, or recurrence of other venous thrombotic event (VTE) remain incompletely defined. Accurate pooled estimates are essential to guide secondary prevention strategies and the duration of anticoagulation. Objective To quantify pooled risks of recurrent CVT, other VTE after a first CVT and to compare outcomes by anticoagulant class. Methods We conducted a systematic search was performed from inception to March 2025. Eligible studies reported post‐index CVT recurrence and/or VTE. Outcomes were pooled using random‐effects meta‐analysis. Prespecified subgroups included anticoagulation status, subtypes, and major bleeding at follow‐up. Results Fifty‐four studies (N=9,985 patients after first CVT) met inclusion criteria. The pooled CVT recurrence rate was 2.87% (P<0.0001; I2 = 92.3%), and the pooled VTE rate was 3.84% (P <0.0001, I2 = 83.1%). In studies reporting anticoagulation intake, the pooled CVT and VTE recurrence rate was 3.87% (p<0.0001, I2 = 97.5%). A small percentage of CVT/VTE recurrence occurred in relation to anticoagulation either subtherapeutic effect or discontinuation (4.9% and 6.8% respectively). DOACs were associated with fewer VTE recurrences in comparison to vitamin K antagonists (VKA), (RR,0.82 95% CI, 0.69‐0.99, p = 0.9, I2 = 0%), while CVT recanalization did not differ (OR, 0.91 95% CI, 0.57‐1.44, p = 0.09, I2 = 54.3%), major bleeding complication was significantly lower in DOAC than VKA (OR, 0.65 95% CI, 0.46‐0.91, p = 0.13, I2 = 0.0% Conclusion After a first CVT, recurrent CVT and subsequent VTE are infrequent but clinically meaningful. Anticoagulation, particularly DOACs, appears to reduce recurrence with lower bleeding complication comparable to VKAs. These findings support DOACs as a reasonable alternative for secondary prevention, while high‐quality randomized trials are needed to define optimal long‐term strategies and patient selection. image image
Amenábar et al. (Sat,) studied this question.