Antiplatelets or anticoagulants? Secondary prevention in cervical artery dissection: an updated meta-analysis
Ei Zune The1,2,3, Ne Naing Lin4, Ching Jocelyn Chan5
1Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore. eizune.the@nhs.net.
Insights
For extracranial artery dissection, neither antiplatelet nor anticoagulant therapy showed a significant advantage in preventing recurrent ischemic events or death. Treatment decisions should be individualized based on patient-specific factors.
Area of Science:
- Neurology
- Vascular Medicine
- Clinical Trials
Background:
- Extracranial artery dissection (internal carotid or vertebral arteries) is a leading cause of stroke in adults under 50.
- Current evidence is inconclusive regarding the optimal medical treatment (antiplatelets vs. anticoagulants).
Purpose of the Study:
- To compare the efficacy of antiplatelets versus anticoagulants for secondary prevention in extracranial artery dissection.
- To evaluate outcomes including ischemic stroke, transient ischemic attack (TIA), and death.
Main Methods:
- A systematic meta-analysis adhering to PRISMA 2020 guidelines.
- Searched Medline, CENTRAL, and ClinicalTrials.gov up to May 2021.
- Included 2 RCTs and 64 observational studies.
Main Results:
- No statistically significant differences were observed between antiplatelet and anticoagulant treatments.
- Outcomes of stroke, stroke or TIA, and death were numerically higher with antiplatelets but not significant.
Conclusions:
- Antiplatelet and anticoagulation therapies demonstrate comparable effectiveness in managing extracranial artery dissection.
- Individual patient characteristics should guide the selection of antithrombotic treatment.
Background:
Extracranial artery dissection involving either internal carotid artery or vertebral artery is a major cause of stroke in adults under 50 years of age. There is no conclusive evidence whether antiplatelets or anticoagulants are better suited in the treatment of extracranial artery dissection.
Objectives:
To determine whether antiplatelets or anticoagulants have advantage over the other in the treatment of extracranial artery dissection for secondary prevention of recurrent ischemic events or death.
Methods:
Present meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement. Database search was done in Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov from inception to May 2021 using pre-defined search strategy. Additional studies were identified from reference lists from included studies, reviews and previous meta-analyses. Outcome measures were ischaemic stroke, ischaemic stroke or transient ischaemic attack (TIA), and death.
Results:
Two RCTs and 64 observational studies were included in the meta-analysis. While the outcome measures of stroke, stroke or TIA and death were numerically higher with antiplatelet use, there were no statistically significant differences between antiplatelets and anticoagulants.
Conclusion:
We found no significant difference between antiplatelet and anticoagulation treatment after extracranial artery dissection. The choice of treatment should be tailored to individual cases.
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