Anticoagulation Versus Antiplatelets in Spontaneous Cervical Artery Dissection: A Systematic Review and Meta-Analysis.

Yaghi, Shadi; Shu, Liqi; Fletcher, Lauren; Fayad, Fayez H; Shah, Asghar; Herning, Ana; Isho, Noail; Mansour, Perla; Joudi, Kareem; Zaidat, Bashar; Mahmoud, Noor A; Abdul Khalek, Feras; Xiao, Han; Goldstein, Eric; Ghannam, Malik; Siegler, James E; Salehi Omran, Setareh; Bakradze, Ekaterina; Nguyen, Thanh N; Keser, Zafer; ... (2024). Anticoagulation Versus Antiplatelets in Spontaneous Cervical Artery Dissection: A Systematic Review and Meta-Analysis. Stroke, 55(7), pp. 1776-1786. American Heart Association 10.1161/STROKEAHA.124.047310

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BACKGROUND

It is uncertain whether antiplatelets or anticoagulants are more effective in preventing early recurrent stroke in patients with cervical artery dissection. Following the publication of the observational Antithrombotic for STOP-CAD (Stroke Prevention in Cervical Artery Dissection) study, which has more than doubled available data, we performed an updated systematic review and meta-analysis comparing antiplatelets versus anticoagulation in cervical artery dissection.

METHODS

The systematic review was registered in PROSPERO (CRD42023468063). We searched 5 databases using a combination of keywords that encompass different antiplatelets and anticoagulants, as well as cervical artery dissection. We included relevant randomized trials and included observational studies of dissection unrelated to major trauma. Where studies were sufficiently similar, we performed meta-analyses for efficacy (ischemic stroke) and safety (major hemorrhage, symptomatic intracranial hemorrhage, and death) outcomes using relative risks.

RESULTS

We identified 11 studies (2 randomized trials and 9 observational studies) that met the inclusion criteria. These included 5039 patients (30% [1512] treated with anticoagulation and 70% [3527]) treated with antiplatelets]. In meta-analysis, anticoagulation was associated with a lower ischemic stroke risk (relative risk, 0.63 [95% CI, 0.43 to 0.94]; P=0.02; I2=0%) but higher major bleeding risk (relative risk, 2.25 [95% CI, 1.07 to 4.72]; P=0.03, I2=0%). The risks of death and symptomatic intracranial hemorrhage were similar between the 2 treatments. Effect sizes were larger in randomized trials. There are insufficient data on the efficacy and safety of dual antiplatelet therapy or direct oral anticoagulants.

CONCLUSIONS

In this study of patients with cervical artery dissection, anticoagulation was superior to antiplatelet therapy in reducing ischemic stroke but carried a higher major bleeding risk. This argues for an individualized therapeutic approach incorporating the net clinical benefit of ischemic stroke reduction and bleeding risks. Large randomized clinical trials are required to clarify optimal antithrombotic strategies for management of cervical artery dissection.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Heldner, Mirjam Rachel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4628

Publisher:

American Heart Association

Language:

English

Submitter:

Pubmed Import

Date Deposited:

11 Jun 2024 09:28

Last Modified:

25 Jun 2024 00:16

Publisher DOI:

10.1161/STROKEAHA.124.047310

PubMed ID:

38847098

Uncontrolled Keywords:

anticoagulation antiplatelet cervical artery dissection stroke

BORIS DOI:

10.48350/197661

URI:

https://boris.unibe.ch/id/eprint/197661

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