Anticoagulation in the management  of septic cavernous sinus thrombosis secondary to rhino-orbito-cerebral mucormycosis: A retrospective  real-world experience

Kiana Amani; Mojtaba Shahbazi; Atefeh Behkar; Ghasem Farahmand; Shima Ghafouri; Sanaz Heydari; Maryam Kaeedi; Hana Magrouni; Fatemeh Alizadeh; Mojdeh Ghabaee; Payam Sarraf; Abbas Tafakhori; Hamed Amirifard; Sakineh  Ranji-Burachaloo; Seyed Ehsan Mohammadianinejad; Melika Jameie; Mohammad Hossein Harirchian

doi:10.18502/cjn.v23i1.16432

Kiana Amani Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mojtaba Shahbazi Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Atefeh Behkar School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Ghasem Farahmand Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Shima Ghafouri Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Sanaz Heydari Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Maryam Kaeedi Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Hana Magrouni Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Alizadeh Neurology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mojdeh Ghabaee Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Payam Sarraf Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abbas Tafakhori Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Hamed Amirifard Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Sakineh Ranji-Burachaloo Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ehsan Mohammadianinejad Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Melika Jameie Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Hossein Harirchian Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cjn.v23i1.16432

Keywords: Cavernous Sinus Thrombosis; Septic; Anticoagulants; Mucormycosis; COVID-19; Treatment Outcome

Abstract

Background: COVID-19 was associated with an increased number of patients with mucormycosis (MCR), followed by septic cavernous sinus thrombosis (SCST). We evaluated the association between anticoagulation (AC) and mortality/morbidity of COVID-19-associated MCR (CAM)-induced SCST.

Methods: In this retrospective study, neurological sequelae, functional outcomes, and in-hospital mortality were compared between AC receivers and non-receivers. In addition, the association between AC and survivability was examined.

Results: Twenty-nine patients (17 male; mean age: 51.27 years) with CAM-induced SCST were included in the study. The median intervals between COVID-19 and MCR, and COVID-19 and SCST were 19 and 27 days, respectively.

AC initiation was 18 days, with an AC duration of 37 days. Baseline and management-related characteristics were comparable between AC recipients and non-recipients (P > 0.050). AC receivers (n = 15) and non-receivers (n = 14) did not significantly differ in terms of the proportion of sequelae (6/15 vs. 5/14; P = 1.000), complete recovery (2/15 vs. 4/14; P = 0.687), and in-hospital mortality (3/15 vs. 3/14; P > 0.999). Nevertheless, AC recipients had a longer hospital stay (72.0 vs. 35.5; P = 0.016). AC-related characteristics (AC receiving, type, early initiation, and duration) were not significantly different between survivors and non-survivors, or between recovered and disabled patients.

Conclusion: In our study, CAM-induced SCST in-hospital mortality/morbidity did not differ between AC receivers and non-receivers. AC characteristics were not different between survivors and non-survivors, or recovered and disabled patients. However, the small sample size may have limited the ability to detect significant differences, leading to inconclusive results.