Antithrombotic Treatment for Cervical Artery Dissection
Authors: Kaufmann Josefin E. , Harshfield Eric L. , Gensicke Henrik , Wegener Susanne , Michel Patrik , Kägi Georg , Nedeltchev Krassen , Kellert Lars , Rosenbaum Sverre , Nolte Christian H. , Christensen Hanne , Arnold Marcel , Lyrer Philippe , Levi Christopher , Bath Philip M. , Engelter Stefan T. , Traenka Christopher , Markus Hugh S. ,   CADISS and TREAT-CAD Investigators, Azlisham Mohd Nor , Boswell Rose , Baldwin Neil , Rudd Anthoy , Burger Isle , Kalra Lalit , Hassan Ahamed , Price Christopher , Dixit Anand , MacWalter Ronald , Cohen David , Davey Richard , Cassidy Tim , Gunathilagan Gunarathnam , Jenkinson Damian , Harrington Frances , James Martin , Venables Graham , Smyth Nigel , Emsley Hedley , Shaw Louise , Lovett Joanna , Guyler Paul , Markus Hugh S , Gompertz Patrick , Kelly Debs , Salih Isam , Davies Brendan , Shetty Hamsaraj , Mistri Amit , Hargrovers David , Rashed Khalid , Clarke Brian , Collas David , Colam Bridget , Salman Rustam Al-Shahi , Gerraty Richard , Sturm Jon , Levi Christopher , Kleinig Tim , Wrong Andrew , Hand Peter , Delcourt Candice , King Alice , Madigan Jeremy , Morley Atkinson , Norris John , Peycke Jennifer , Wilson Melina , Hicks Cara , Hayter Elizabeth , Menon Ranjit , Kennedy Fiona , Khan Usman , Feldman Adina , Hollocks Matt , Venebales Graham S , Kerry Sally , Hassan Ahames , Ford Gary A , Bath Philip M , Weir Chris , Briley Deniy , Bhalla Ajay , Engelter Stefan , Traenka Christopher , Schaedelin Sabine , Lyrer Philippe , Kloss M , Droste D , Brandt T , Psychogius MN , Brehm A , Grau A , Sandor P , von Felten S , Hammann A , Fabbro Thomas , Maurer Martina , Ehrlich Klaus , Rösler Astrid , Forst P , Kahles Timo , Nedeltchev Krassen , Altersberger Valerian , Bonati Leo , Brehm Alexander , Bruni N , de Marchis Gian-Marco , Fisch Urs , Fladt Joachim , Gensicke Henrik , Hert Lisa , Peters Nils , Polymeris Alexandros , Stippich C , Thilemann Sebastian , Wagner Benjamin , Arnold Marcel , Fischer Urs , Heldner MR , Seiffge David J , Sveikata L , Sztajzel R , Muller H , Correia P , Eskandari A , Meyer I , Michel Patrik , Nannoni S , Remillard S , Sirimarco G , Zachariadis A , Kaegi Georg , Mueller A , Vehoff Jochen , Hamann J , Luft Andreas , Steiner L , Wegener Susanne , Erdur JH , Nolte Christian , v. Rennenberg R , Scheitz JF , Fell K , Kellert L , Christensen Hanne , Rosenbaum S 
Published: May 2024

Importance

Cervical artery dissection is the most common cause of stroke in younger adults. To date, there is no conclusive evidence on which antithrombotic therapy should be used to treat patients.

Objective

To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection.

Data Sources

PubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023.

Study Selection

Randomized clinical trials that investigated the effectiveness and safety of antithrombotic treatment (antiplatelets vs anticoagulation) in patients with cervical artery dissection were included in the meta-analysis. The primary end point was required to include a composite of (1) any stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up.

Data Extraction/Synthesis

Two independent investigators performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inconsistencies were resolved by a principal investigator.

Main Outcomes and Measures

The primary outcome was a composite of (1) ischemic stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up. The components of the composite outcome were also secondary outcomes. Subgroup analyses based on baseline characteristics with a putative association with the outcome were performed. Logistic regression was performed using the maximum penalized likelihood method including interaction in the subgroup analyses.

Results

Two randomized clinical trials, Cervical Artery Dissection in Stroke Study and Cervical Artery Dissection in Stroke Study and the Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection, were identified, of which all participants were eligible. A total of 444 patients were included in the intention-to-treat population and 370 patients were included in the per-protocol population. Baseline characteristics were balanced. There were fewer primary end points in those randomized to anticoagulation vs antiplatelet therapy (3 of 218 [1.4%] vs 10 of 226 [4.4%]; odds ratio [OR], 0.33 [95% CI, 0.08-1.05]; P = .06), but the finding was not statistically significant. In comparison with aspirin, anticoagulation was associated with fewer strokes (1 of 218 [0.5%] vs 10 of 226 [4.0%]; OR, 0.14 [95% CI, 0.02-0.61]; P = .01) and more bleeding events (2 vs 0).

Conclusions and Relevance

This individual patient data meta-analysis of 2 currently available randomized clinical trial data found no significant difference between anticoagulants and antiplatelets in preventing early recurrent events.