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Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis

Fiona Kennedy1, Silvia Lanfranconi, Cara Hicks

  • 1Stroke and Dementia Research Centre, St George’s University of London, London, UK.

Neurology
|August 3, 2012
PubMed

Insights

Comparing anticoagulation and antiplatelet therapy for preventing recurrent stroke after carotid and vertebral dissection shows no clear superiority. More randomized studies are needed to confirm findings from nonrandomized trials.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Clinical Trials

Background:

  • Cervical artery dissection is a leading cause of stroke in young adults.
  • Current treatment strategies include anticoagulation and antiplatelet therapy, but evidence comparing their efficacy is limited.
  • The Cervical Artery Dissection in Stroke Study (CADISS-NR) aimed to address this knowledge gap.

Purpose of the Study:

  • To present results from the nonrandomized arm of the CADISS trial comparing anticoagulation and antiplatelets.
  • To conduct a meta-analysis of these results with previously published studies.
  • To evaluate the effectiveness of these treatments in preventing recurrent stroke after carotid and vertebral dissection.

Main Methods:

  • Recruitment of 88 patients with extracranial carotid and vertebral dissection within 1 month of symptom onset across 22 centers.
  • Primary endpoint: recurrent stroke at 3 months.
  • Systematic review and meta-analysis of published studies combined with CADISS-NR data.

Main Results:

  • In CADISS-NR, recurrent ischemic stroke occurred in 1.69% of antiplatelet patients and 3.57% of anticoagulation patients.
  • At 3 months, 5.08% of antiplatelet patients experienced TIA, versus none in the anticoagulation group.
  • Meta-analysis of 1,636 patients from 40 studies showed no significant difference in recurrent stroke risk (OR 1.49) or death risk (OR 1.27) between treatments.

Conclusions:

  • No definitive evidence supports the superiority of anticoagulation or antiplatelet therapy for stroke prevention post-dissection.
  • All available data stem from nonrandomized studies, highlighting the need for randomized controlled trials.
  • CADISS-NR data suggest a potentially lower recurrent stroke rate than some prior studies.
Abstract

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