Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Area of Science:

• Neurology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Cervical artery dissection (CAD) stroke prevention strategies lack definitive evidence from small trials.
• Optimal antithrombotic therapy for CAD remains debated, with conflicting results for antiplatelets versus anticoagulation.

Purpose of the Study:

• To compare the effectiveness and safety of anticoagulation versus antiplatelet therapy in patients with cervical artery dissection.
• To evaluate risks of subsequent ischemic stroke and major hemorrhage in CAD patients based on antithrombotic treatment.

Main Methods:

• Multicenter, retrospective, international observational study of 3636 patients with non-traumatic cervical artery dissection.
• Comparison of anticoagulation versus antiplatelets using adjusted Cox regression with inverse probability of treatment weighting.
• Outcomes assessed included subsequent ischemic stroke and major hemorrhage within 30 and 180 days.

Main Results:

• Anticoagulation showed a nonsignificant trend toward lower ischemic stroke risk by day 30 and 180 compared to antiplatelets.
• Anticoagulation was associated with a significantly higher risk of major hemorrhage by day 180 (aHR, 5.56).
• Patients with occlusive dissection had a significantly lower ischemic stroke risk with anticoagulation (aHR, 0.40).

Conclusions:

• Anticoagulation may reduce ischemic stroke risk in cervical artery dissection, particularly in occlusive cases.
• The increased risk of major hemorrhage with anticoagulation by 180 days suggests considering a switch to antiplatelets.
• Large prospective studies are required to confirm these findings and guide treatment decisions.