Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients
D Georgiadis1, M Arnold, H C von Buedingen
1Department of Neurology, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland. dimitrios.georgiadis@usz.ch
Insights
Aspirin and anticoagulants show similar safety and efficacy for spontaneous cervical carotid artery dissection. New ischemic events are rare and not significantly different between treatment groups.
Area of Science:
- Neurology
- Vascular Medicine
- Cardiology
Background:
- Spontaneous dissection of the cervical carotid artery (sICAD) lacks comparative randomized studies on aspirin versus anticoagulants.
- Efficacy and safety data for antithrombotic treatments in sICAD patients are limited.
Purpose of the Study:
- To compare the efficacy and safety of aspirin versus anticoagulants in patients with spontaneous cervical carotid artery dissection.
- To evaluate the frequency of new ischemic events and bleeding complications in sICAD patients treated with different antithrombotic agents.
Main Methods:
- Retrospective analysis of prospectively collected data from 298 sICAD patients.
- Patients were treated with either anticoagulants (n=202) or aspirin (n=96).
- Outcomes included new cerebral/retinal ischemic events, symptomatic intracranial hemorrhage, and major extracranial bleeding, assessed at 3-month follow-up.
Main Results:
- Ischemic events (stroke, TIA, retinal ischemia) were infrequent overall.
- No significant difference in the frequency of new ischemic events between anticoagulant (5.9%) and aspirin (2.1%) groups.
- Hemorrhagic adverse events were also similar between the two treatment groups (anticoagulants 2%, aspirin 1%).
- New ischemic events were more common in patients presenting with prior ischemic events (6.2%) compared to those with local symptoms or asymptomatic (1.1%).
Conclusions:
- In this nonrandomized study, aspirin and anticoagulants appear to have similar efficacy and safety profiles for sICAD.
- The frequency of new cerebral and retinal ischemic events in sICAD patients is low.
- Treatment choice between aspirin and anticoagulants may not significantly impact ischemic event rates in sICAD.
Background:
No randomized study has yet compared efficacy and safety of aspirin and anticoagulants in patients with spontaneous dissection of the cervical carotid artery (sICAD).
Methods:
Prospectively collected data from 298 consecutive patients with sICAD (56% men; mean age 46 +/- 10 years) treated with anticoagulants alone (n = 202) or aspirin alone (n = 96) were retrospectively analyzed. Admission diagnosis was ischemic stroke in 165, TIA in 37, retinal ischemia in 8, and local symptoms and signs (headache, neck pain, Horner syndrome, cranial nerve palsy) in 80 patients, while 8 patients were asymptomatic. Clinical follow-up was obtained after 3 months by neurologic examination (97% of patients) or structured telephone interview. Outcome measures were 1) new cerebral ischemic events, defined as ischemic stroke, TIA, or retinal ischemia, 2) symptomatic intracranial hemorrhage, and 3) major extracranial bleeding.
Results:
During follow-up, ischemic events were rare (ischemic stroke, 0.3%; TIA, 3.4%; retinal ischemia, 1%); their frequency did not significantly differ between patients treated with anticoagulants (5.9%) and those treated with aspirin (2.1%). The same was true for hemorrhagic adverse events (anticoagulants, 2%; aspirin, 1%). New ischemic events were significantly more frequent in patients with ischemic events at onset (6.2%) than in patients with local symptoms or asymptomatic patients (1.1%).
Conclusions:
Within the limitations of a nonrandomized study, our data suggest that frequency of new cerebral and retinal ischemic events in patients with spontaneous dissection of the cervical carotid artery is low and probably independent of the type of antithrombotic treatment (aspirin or anticoagulants).
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