Antithrombotic treatment for acute extracranial carotid artery dissections: a meta-analysis
M M Chowdhury1, C N Sabbagh1, D Jackson2
1Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK.
Insights
This meta-analysis found no randomized trials comparing anticoagulants or antiplatelet agents to control for carotid artery dissection. Non-randomized studies showed no significant difference between these treatments for stroke patients.
Area of Science:
- Neurology
- Vascular Medicine
- Clinical Trials
Background:
- Carotid artery dissection is a significant cause of stroke in young individuals.
- The prevalence is approximately 2.6-3.0 per 100,000 population.
- Optimal medical management remains under investigation.
Purpose of the Study:
- To evaluate the efficacy of anticoagulants versus antiplatelet agents in medically managed carotid artery dissection patients.
- To compare outcomes including mortality, ischemic stroke, and major bleeding.
Main Methods:
- A comprehensive literature search was conducted across major databases (CENTRAL, MEDLINE, EMBASE) up to March 2015.
- Primary outcomes included all-cause mortality or disability.
- Secondary outcomes comprised ischemic stroke and hemorrhage events.
Main Results:
- No completed randomized trials were identified.
- Analysis of 38 non-randomized studies (1,398 patients) revealed no significant difference between antiplatelet and anticoagulant treatments regarding mortality (ES -0.007, p=0.871).
- No significant differences were observed for death/disability or secondary outcomes.
Conclusions:
- There is a lack of Level 1 evidence from randomized trials to support the routine use of anticoagulants or antiplatelet agents for carotid artery dissection.
- Existing non-randomized studies do not demonstrate a significant difference between anticoagulants and antiplatelet drugs in managing this condition.
Introduction:
Carotid artery dissection is a leading cause of stroke in younger patients, with an associated prevalence of 2.6-3.0 per 100,000 population. This meta-analysis aims to determine whether in patients managed medically, treatment with anticoagulants or antiplatelet agents was associated with a better outcome with respect to mortality, ischaemic stroke, and major bleeding episodes.
Patients And Methods:
A comprehensive search strategy was employed of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to March 2015), and EMBASE (January 1980 to March 2015) databases. Primary outcomes were death (all causes) or disability. Secondary outcomes were ischaemic stroke, symptomatic intracranial haemorrhage, and major extracranial haemorrhage during the reported follow-up period.
Results:
No completed randomized trials were found. Comparing antiplatelets with anticoagulants across 38 studies (1,398 patients), there were no significant differences in the odds of death (effects size, ES, -0.007, p = .871), nor in the death and disability comparison or across any secondary outcomes.
Conclusion:
There were no randomised trials comparing either anticoagulants or antiplatelets with control, thus there is no level 1 evidence to support their routine use for the treatment of carotid artery dissection. Also, there were no randomised trials that directly compared anticoagulants with antiplatelet drugs, and the reported non-randomised studies did not show any evidence of a significant difference between the two.
