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Rivaroxaban in cervical and "cervico-cerebral" artery dissections: a new therapeutic option?

Giovanni Malferrari1, Domenico Laterza2, Franco Valzania1

  • 1Department of Neurology Unit, Azienda USL-IRCCS, Reggio Emilia, RE, Italy.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|April 14, 2019
PubMed

Insights

Direct oral anticoagulants (DOACs) show promise for treating cervical artery dissections (CADs) in young patients. This study found rivaroxaban led to good outcomes, including recanalization and no stroke recurrence.

Area of Science:

  • Vascular Neurology
  • Cardiology
  • Pharmacology

Background:

  • Cervical artery dissections (CADs) are typically managed with antiplatelet agents or vitamin K antagonists (VKAs).
  • Limited data exist on the efficacy and safety of direct oral anticoagulants (DOACs) for CADs.
  • DOACs are increasingly preferred over warfarin for stroke prevention in non-valvular atrial fibrillation due to a favorable safety profile.

Purpose of the Study:

  • To evaluate the use of rivaroxaban, a DOAC, in young patients with cervical artery dissections (CADs) and cervico-cerebral artery dissections (CCADs).
  • To assess the clinical outcomes, including vascular recanalization, stroke recurrence, and bleeding complications, in patients treated with rivaroxaban.

Main Methods:

  • Retrospective case series of four young patients (average age 42) with CADs/CCADs treated with rivaroxaban 20 mg daily.
  • Clinical follow-up, serial neurosonological examinations at 1, 3, and 6 months.
  • Magnetic resonance angiography (MRA) at 6 months for vascular assessment.

Main Results:

  • All four patients achieved good clinical outcomes.
  • Vascular recanalization was observed in all patients.
  • No stroke recurrence or bleeding complications were reported, even in cases with intracranial vertebral artery involvement.

Conclusions:

  • Direct oral anticoagulants (DOACs), specifically rivaroxaban, may be a viable alternative treatment for cervical artery dissections (CADs) in young patients.
  • DOACs could potentially be considered for intracranial artery dissections as well.
  • Further research is warranted to confirm the safety and efficacy of DOACs in this patient population.

Keywords:
Cervical and cervico-cerebral artery dissectionsDOACsNeurosonologyRivaroxabanStrokeTranscranial color Doppler

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