Antithrombotic Treatment for Cervical Artery Dissection: A Systematic Review and Individual Patient Data...

Area of Science:

• Neurology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Cervical artery dissection (CAD) is a leading cause of stroke in young adults.
• Optimal antithrombotic therapy for CAD remains unclear, lacking conclusive evidence.

Purpose of the Study:

• To conduct an individual patient data meta-analysis of randomized clinical trials (RCTs).
• To compare anticoagulants versus antiplatelets for preventing stroke after CAD.

Main Methods:

• Systematic review and meta-analysis of RCTs comparing anticoagulation and antiplatelet therapy in CAD patients.
• Data sourced from PubMed, Cochrane, Embase, and ClinicalTrials.gov up to August 2023.
• Primary outcome: composite of stroke, death, or major bleeding at 90 days.

Main Results:

• Two RCTs with 444 patients (intention-to-treat) were included.
• No statistically significant difference in the primary composite outcome between anticoagulation and antiplatelets (OR 0.33; P=0.06).
• Anticoagulation showed fewer strokes (OR 0.14; P=0.01) but more bleeding events compared to aspirin.

Conclusions:

• Individual patient data meta-analysis of 2 RCTs found no significant difference in preventing early recurrent events between anticoagulants and antiplatelets.
• Current evidence does not definitively favor one antithrombotic strategy over the other for CAD.
• Further research is warranted to establish optimal antithrombotic treatment for CAD.