Apixaban Use in the Management of Cerebral Venous Sinus Thrombosis: Two Cases with Warfarin Resistance and Labile INR

Background: Cerebral venous sinus thrombosis (CVST) treatment primarily relies on effective anticoagulation; following the acute phase, the standard option during the maintenance period is typically vitamin K antagonists (VKA). However, warfarin resistance or a labile international normalized ratio (INR) course are critical barriers that limit an effective treatment process. In this report, two CVST cases where therapeutic targets could not be reached with standard anticoagulant therapy and the experience with apixaban use are presented.Case Presentation: With apixaban (5 mg bid) treatment, complete clinical recovery was achieved in both patients, and total recanalization was detected on magnetic resonance venography (MRV). No recurrent thrombosis or bleeding complications developed during the follow-up period. These cases support that apixaban is an effective and safe alternative in selected CVST cases.Conclusion: Thanks to its predictable pharmacokinetic advantages, apixaban may increase patient compliance and clinical success by eliminating the requirement for routine monitoring.