Antithrombotic Treatment for Cervical Artery Dissection-Reference-Cited by-同舟云学术

Antithrombotic Treatment for Cervical Artery Dissection

Published:2024-06-01 Issue:6 Volume:81 Page:630
ISSN:2168-6149
Container-title:JAMA Neurology
language:en
Short-container-title:JAMA Neurol

Author:

Kaufmann Josefin E.¹²,Harshfield Eric L.³,Gensicke Henrik¹²,Wegener Susanne⁴,Michel Patrik⁵,Kägi Georg⁶⁷,Nedeltchev Krassen⁸,Kellert Lars⁹¹⁰,Rosenbaum Sverre¹¹,Nolte Christian H.¹²¹³,Christensen Hanne¹¹,Arnold Marcel⁶,Lyrer Philippe¹,Levi Christopher¹⁴,Bath Philip M.¹⁵,Engelter Stefan T.¹²,Traenka Christopher¹²,Markus Hugh S.³, ,Azlisham Mohd Nor¹⁶,Boswell Rose¹⁶,Baldwin Neil¹⁶,Rudd Anthoy¹⁶,Burger Isle¹⁶,Kalra Lalit¹⁶,Hassan Ahamed¹⁶,Price Christopher¹⁶,Dixit Anand¹⁶,MacWalter Ronald¹⁶,Cohen David¹⁶,Davey Richard¹⁶,Cassidy Tim¹⁶,Gunathilagan Gunarathnam¹⁶,Jenkinson Damian¹⁶,Harrington Frances¹⁶,James Martin¹⁶,Venables Graham¹⁶,Smyth Nigel¹⁶,Emsley Hedley¹⁶,Shaw Louise¹⁶,Lovett Joanna¹⁶,Guyler Paul¹⁶,Markus Hugh S¹⁶,Gompertz Patrick¹⁶,Kelly Debs¹⁶,Salih Isam¹⁶,Davies Brendan¹⁶,Shetty Hamsaraj¹⁶,Mistri Amit¹⁶,Hargrovers David¹⁶,Rashed Khalid¹⁶,Clarke Brian¹⁶,Collas David¹⁶,Colam Bridget¹⁶,Salman Rustam Al-Shahi¹⁶,Gerraty Richard¹⁶,Sturm Jon¹⁶,Levi Christopher¹⁶,Kleinig Tim¹⁶,Wrong Andrew¹⁶,Hand Peter¹⁶,Delcourt Candice¹⁶,King Alice¹⁶,Madigan Jeremy¹⁶,Morley Atkinson¹⁶,Norris John¹⁶,Peycke Jennifer¹⁶,Wilson Melina¹⁶,Hicks Cara¹⁶,Hayter Elizabeth¹⁶,Menon Ranjit¹⁶,Kennedy Fiona¹⁶,Khan Usman¹⁶,Feldman Adina¹⁶,Hollocks Matt¹⁶,Venebales Graham S¹⁶,Kerry Sally¹⁶,Hassan Ahames¹⁶,Ford Gary A¹⁶,Bath Philip M¹⁶,Weir Chris¹⁶,Briley Deniy¹⁶,Bhalla Ajay¹⁶,Engelter Stefan¹⁶,Traenka Christopher¹⁶,Schaedelin Sabine¹⁶,Lyrer Philippe¹⁶,Kloss M¹⁶,Droste D¹⁶,Brandt T¹⁶,Psychogius MN¹⁶,Brehm A¹⁶,Grau A¹⁶,Sandor P¹⁶,von Felten S¹⁶,Hammann A¹⁶,Fabbro Thomas¹⁶,Maurer Martina¹⁶,Ehrlich Klaus¹⁶,Rösler Astrid¹⁶,Forst P¹⁶,Kahles Timo¹⁶,Nedeltchev Krassen¹⁶,Altersberger Valerian¹⁶,Bonati Leo¹⁶,Brehm Alexander¹⁶,Bruni N¹⁶,de Marchis Gian-Marco¹⁶,Fisch Urs¹⁶,Fladt Joachim¹⁶,Gensicke Henrik¹⁶,Hert Lisa¹⁶,Peters Nils¹⁶,Polymeris Alexandros¹⁶,Stippich C¹⁶,Thilemann Sebastian¹⁶,Wagner Benjamin¹⁶,Arnold Marcel¹⁶,Fischer Urs¹⁶,Heldner MR¹⁶,Seiffge David J¹⁶,Sveikata L¹⁶,Sztajzel R¹⁶,Muller H¹⁶,Correia P¹⁶,Eskandari A¹⁶,Meyer I¹⁶,Michel Patrik¹⁶,Nannoni S¹⁶,Remillard S¹⁶,Sirimarco G¹⁶,Zachariadis A¹⁶,Kaegi Georg¹⁶,Mueller A¹⁶,Vehoff Jochen¹⁶,Hamann J¹⁶,Luft Andreas¹⁶,Steiner L¹⁶,Wegener Susanne¹⁶,Erdur JH¹⁶,Nolte Christian¹⁶,v. Rennenberg R¹⁶,Scheitz JF¹⁶,Fell K¹⁶,Kellert L¹⁶,Christensen Hanne¹⁶,Rosenbaum S¹⁶

Affiliation:

1. Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland

2. Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland

3. Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom

4. Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, and University of Zurich, Switzerland

5. Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

6. Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland

7. Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland

8. Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland

9. Department of Neurology, Ludwig Maximilian University, Munich, Germany

10. Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany

11. Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark

12. Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charite-Universitätsmedizin Berlin, Berlin, Germany

13. Berlin Institute of Healths at Charite, Charite-Universitätsmedizin Berlin, Berlin, Germany

14. Faculty of Health and Medicine, University of Newcastle, and John Hunter Hospital, Newcastle, Australia

15. Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom

16. for the CADISS and TREAT-CAD Investigators

Abstract

ImportanceCervical 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.ObjectiveTo perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection.Data SourcesPubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023.Study SelectionRandomized 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.Data Extraction/SynthesisTwo 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.Main Outcomes and MeasuresThe 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.ResultsTwo 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).Conclusions and RelevanceThis 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.

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamaneurology/articlepdf/2818521/jamaneurology_kaufmann_2024_oi_240023_1717440889.72689.pdf

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