Introduction: Cerebral venous thrombosis (CVT) generally has favorable outcomes, yet the risk of recurrence and other venous thrombotic events (VTE) remains a critical concern for long-term management. 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, and all-cause mortality 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 and mortality. Outcomes were pooled using random-effects meta-analysis. Prespecified subgroups included anticoagulation status, subtypes, and CVT recanalization 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; I 2 = 92.3%), and the pooled VTE rate was 3.84% ( P <0.0001, I 2 = 83.1%). All-cause mortality was 5.45% ( p <0.0001, I 2 = 91.5%). In studies reporting anticoagulation intake, pooled recurrence had CVT and VTE recurrence rates of 3.87% ( p <0.0001, I 2 = 97.5%). 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, I 2 = 0%), and CVT recanalization did not differ,(OR, 0.91 95% CI, 0.57-1.44, p = 0.09, I 2 = 54.3%). Conclusion: After a first CVT, recurrent CVT and subsequent VTE are infrequent but clinically meaningful. Anticoagulation, particularly DOACs, appears to reduce recurrence with recanalization 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.
Abdelhakim et al. (Thu,) studied this question.