Specific Features of Cerebral Venous Thrombosis Associated With Iron Deficiency Anemia

10 Mar 20264 min read0 viewsJournal Feed

GIST

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundAnemia has emerged as a risk factor for cerebral venous thrombosis (CVT) and has been associated with poorer outcomes.

A specific association has been observed with microcytic anemia, most commonly caused by iron deficiency anemia (IDA). However, detailed data on the clinical, radiological, and therapeutic profile of CVT in patients with IDA remain limited.MethodsWe analyzed consecutive patients with CVT and moderate or severe IDA from the prospective Lariboisière Hospital cohort with CVT (1998–2023).

Patients with other types of anemia were excluded. Clinical, neuroimaging, treatment, and outcome data were compared with those of patients with CVT without anemia.ResultsAmong 616 patients with CVT, 64 (10.4%) had moderate or severe IDA.

Most were women (96.9%), with chronic gynecological bleeding (eg, fibroids, adenomyosis) as the predominant cause. All received anticoagulation.

Additional treatments included iron supplementation, blood transfusion, gynecological surgery, and gonadotropin‐releasing hormone analogs.

Clinical Editorial

Background and scope

The study investigates cerebral venous thrombosis (CVT) in the setting of moderate to severe iron deficiency anemia (IDA), a context linked to worse initial presentations, with limited detailed data on clinical, radiologic, and therapeutic aspects to date.
The analysis is based on consecutive CVT cases from the Lariboisière Hospital prospective cohort spanning 1998–2023, focusing on those with IDA and excluding other anemia types.

Study design and population

Among 616 CVT patients, 64 (10.4%) met criteria for moderate or severe IDA.
The cohort with IDA predominantly comprised young women, with gynecologic sources of blood loss (e.g., fibroids, adenomyosis) identified as the main etiologic contributor.
All patients with IDA received anticoagulation; additional management included iron supplementation, transfusion, gynecologic surgery, and therapy with gonadotropin-releasing hormone analogs as indicated.

Clinical and radiologic presentation

Compared with CVT patients without anemia (n = 502), those with IDA more frequently exhibited focal neurological deficits at presentation and a higher incidence of parenchymal lesions.
Venous infarctions were notably more common in the IDA group (32.8% vs 14.5%).

Outcomes and interpretation

Despite presenting with more severe initial clinical and radiographic findings, long-term functional outcomes at 1 year did not differ significantly between IDA-associated CVT and non-IDA CVT groups.
Adjusted analysis suggested no clear difference in the likelihood of an excellent outcome (odds ratio 0.60; 95% CI, 0.23–1.52), reflecting uncertainty and lack of robust comparative advantage for IDA status on recovery.

Contextual conclusions

IDA emerges as a prevalent comorbidity in CVT that affects a predominantly young female population with potentially treatable etiologies.
While initial severity tends to be greater in the presence of IDA, subsequent long-term outcomes align with those observed in CVT patients without anemia.