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

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.