Abstract Body: Background
Randomized trials and observational of patients with cervical artery dissection showed no significant difference in ischemic stroke risk with anticoagulation versus antiplatelet therapy. Occlusive dissection is a high-risk subgroup that may potentially benefit from anticoagulation. In this study, we aim to determine whether anticoagulation is effective in reducing ischemic stroke rates in patients with occlusive cervical artery dissection using subgroup data from the Cervical Artery Dissection in Stroke Study (CADISS), Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection (TREAT-CAD), and Antithrombotic therapy for Stroke Prevention In Patients with Cervical Artery Dissection (STOP-CAD).
Methods
We stratified patients across the antiplatelet versus anticoagulation groups in the TREAT-CAD, CADISS, and STOP-CAD studies by occlusion status (occlusive versus non-occlusive dissection). The outcome was ischemic stroke during follow up. We performed a meta-analysis for ischemic stroke with anticoagulation vs. antiplatelet using relative risks.
Results
We identified a total of 1626 patients with occlusive cervical artery dissection. In patients with occlusive cervical artery dissection, the risk of ischemic stroke was 1.7% on anticoagulation vs. 6.3% on antiplatelet therapy (RR 0.33 95% CI 0.16-0.68, p<0.001) without significant statistical heterogeneity (I²= 0%). This effect was numerically more pronounced in randomized controlled trials but with overlapping confidence intervals (RR 0.19 95% CI 0.02-1.55, p = 0.12, I² = 0%).
Conclusion
The subgroup analysis of TREAT-CAD, CADISS, and the STOP-CAD studies showed a lower risk of ischemic stroke with anticoagulation in patients with occlusive dissection.