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

Details

Serval ID
serval:BIB_59C2123779CC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Antithrombotic Treatment for Cervical Artery Dissection: A Systematic Review and Individual Patient Data Meta-Analysis.
Journal
JAMA neurology
Author(s)
Kaufmann J.E., Harshfield E.L., Gensicke H., Wegener S., Michel P., Kägi G., Nedeltchev K., Kellert L., Rosenbaum S., Nolte C.H., Christensen H., Arnold M., Lyrer P., Levi C., Bath P.M., Engelter S.T., Traenka C., Markus H.S.
Working group(s)
CADISS and TREAT-CAD Investigators
Contributor(s)
Azlisham M.N., Boswell R., Baldwin N., Rudd A., Burger I., Kalra L., Hassan A., Price C., Dixit A., MacWalter R., Cohen D., Davey R., Cassidy T., Gunathilagan G., Jenkinson D., Harrington F., James M., Venables G., Smyth N., Emsley H., Shaw L., Lovett J., Guyler P., Markus H.S., Gompertz P., Kelly D., Salih I., Davies B., Shetty H., Mistri A., Hargrovers D., Rashed K., Clarke B., Collas D., Colam B., Salman R.A., Gerraty R., Sturm J., Levi C., Kleinig T., Wrong A., Hand P., Delcourt C., King A., Madigan J., Morley A., Norris J., Peycke J., Wilson M., Hicks C., Hayter E., Menon R., Kennedy F., Khan U., Feldman A., Hollocks M., Venebales G.S., Kerry S., Hassan A., Ford G.A., Bath P.M., Weir C., Briley D., Bhalla A., Engelter S., Traenka C., Schaedelin S., Lyrer P., Kloss M., Droste D., Brandt T., Psychogius M.N., Brehm A., Grau A., Sandor P., von Felten S., Hammann A., Fabbro T., Maurer M., Ehrlich K., Rösler A., Forst P., Kahles T., Nedeltchev K., Altersberger V., Bonati L., Brehm A., Bruni N., de Marchis G.M., Fisch U., Fladt J., Gensicke H., Hert L., Peters N., Polymeris A., Stippich C., Thilemann S., Wagner B., Arnold M., Fischer U., Heldner M.R., Seiffge D.J., Sveikata L., Sztajzel R., Muller H., Correia P., Eskandari A., Meyer I., Michel P., Nannoni S., Remillard S., Sirimarco G., Zachariadis A., Kaegi G., Mueller A., Vehoff J., Hamann J., Luft A., Steiner L., Wegener S., Erdur J.H., Nolte C., V Rennenberg R., Scheitz J.F., Fell K., Kellert L., Christensen H., Rosenbaum S.
ISSN
2168-6157 (Electronic)
ISSN-L
2168-6149
Publication state
Published
Issued date
01/06/2024
Peer-reviewed
Oui
Volume
81
Number
6
Pages
630-637
Language
english
Notes
Publication types: Journal Article ; Systematic Review ; Meta-Analysis
Publication Status: ppublish
Abstract
Cervical artery dissection is the most common cause of stroke in younger adults. To date, there is no conclusive evidence on which antithrombotic therapy should be used to treat patients.
To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection.
PubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023.
Randomized clinical trials that investigated the effectiveness and safety of antithrombotic treatment (antiplatelets vs anticoagulation) in patients with cervical artery dissection were included in the meta-analysis. The primary end point was required to include a composite of (1) any stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up.
Two independent investigators performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inconsistencies were resolved by a principal investigator.
The primary outcome was a composite of (1) ischemic stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up. The components of the composite outcome were also secondary outcomes. Subgroup analyses based on baseline characteristics with a putative association with the outcome were performed. Logistic regression was performed using the maximum penalized likelihood method including interaction in the subgroup analyses.
Two randomized clinical trials, Cervical Artery Dissection in Stroke Study and Cervical Artery Dissection in Stroke Study and the Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection, were identified, of which all participants were eligible. A total of 444 patients were included in the intention-to-treat population and 370 patients were included in the per-protocol population. Baseline characteristics were balanced. There were fewer primary end points in those randomized to anticoagulation vs antiplatelet therapy (3 of 218 [1.4%] vs 10 of 226 [4.4%]; odds ratio [OR], 0.33 [95% CI, 0.08-1.05]; P = .06), but the finding was not statistically significant. In comparison with aspirin, anticoagulation was associated with fewer strokes (1 of 218 [0.5%] vs 10 of 226 [4.0%]; OR, 0.14 [95% CI, 0.02-0.61]; P = .01) and more bleeding events (2 vs 0).
This individual patient data meta-analysis of 2 currently available randomized clinical trial data found no significant difference between anticoagulants and antiplatelets in preventing early recurrent events.
Keywords
Humans, Vertebral Artery Dissection/drug therapy, Vertebral Artery Dissection/complications, Fibrinolytic Agents/therapeutic use, Platelet Aggregation Inhibitors/therapeutic use, Anticoagulants/therapeutic use, Anticoagulants/adverse effects, Randomized Controlled Trials as Topic, Stroke/prevention & control, Stroke/drug therapy, Stroke/etiology, Carotid Artery, Internal, Dissection/drug therapy
Pubmed
Create date
16/05/2024 14:58
Last modification date
14/06/2024 7:02
Usage data