Kaufmann, Josefin E; Gensicke, Henrik; Schaedelin, Sabine; Luft, Andreas R; Goeggel-Simonetti, Barbara; Fischer, Urs; Michel, Patrik; Strambo, Davide; Kägi, Georg; Vehoff, Jochen; Nedeltchev, Krassen; Kahles, Timo; Kellert, Lars; Rosenbaum, Sverre; von Rennenberg, Regina; Riegler, Christoph; Seiffge, David; Sarikaya, Hakan; Zietz, Annaelle; Wischmann, Johannes; ... (2024). Toward Individual Treatment in Cervical Artery Dissection: Subgroup Analysis of the TREAT-CAD Randomized Trial. Annals of neurology, 95(5), pp. 886-897. Wiley-Blackwell 10.1002/ana.26886
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OBJECTIVE
Uncertainty remains regarding antithrombotic treatment in cervical artery dissection. This analysis aimed to explore whether certain patient profiles influence the effects of different types of antithrombotic treatment.
METHODS
This was a post hoc exploratory analysis based on the per-protocol dataset from TREAT-CAD (NCT02046460), a randomized controlled trial comparing aspirin to anticoagulation in patients with cervical artery dissection. We explored the potential effects of distinct patient profiles on outcomes in participants treated with either aspirin or anticoagulation. Profiles included (1) presenting with ischemia (no/yes), (2) occlusion of the dissected artery (no/yes), (3) early versus delayed treatment start (</>median), and (4) intracranial extension of the dissection (no/yes). Outcomes included clinical (stroke, major hemorrhage, death) and magnetic resonance imaging outcomes (new ischemic or hemorrhagic brain lesions) and were assessed for each subgroup in separate logistic models without adjustment for multiple testing.
RESULTS
All 173 (100%) per-protocol participants were eligible for the analyses. Participants without occlusion had decreased odds of events when treated with anticoagulation (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.07-0.86). This effect was more pronounced in participants presenting with cerebral ischemia (n = 118; OR = 0.16, 95% CI = 0.04-0.55). In the latter, those with early treatment (OR = 0.26, 95% CI = 0.07-0.85) or without intracranial extension of the dissection (OR = 0.34, 95% CI = 0.11-0.97) had decreased odds of events when treated with anticoagulation.
INTERPRETATION
Anticoagulation might be preferable in patients with cervical artery dissection presenting with ischemia and no occlusion or no intracranial extension of the dissection. These findings need confirmation. ANN NEUROL 2024.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Goeggel Simonetti, Barbara, Fischer, Urs Martin, Kägi, Georg Heinrich, Seiffge, David Julian, Sarikaya, Hakan, Arnold, Marcel |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0364-5134 |
Publisher: |
Wiley-Blackwell |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
19 Feb 2024 12:52 |
Last Modified: |
01 May 2024 00:14 |
Publisher DOI: |
10.1002/ana.26886 |
PubMed ID: |
38362818 |
BORIS DOI: |
10.48350/192966 |
URI: |
https://boris.unibe.ch/id/eprint/192966 |
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