Anticoagulants versus Antiplatelet Treatment in the Medical Management of Carotid Floating Thrombus.

Autor: Aboul-Nour H; Departments of Neurology and Neurosurgery, University of Kentucky, College of Medicine, Lexington, KY, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA., Alshaer Q; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA., Khalid FC; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA., Osehobo E; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA., Tarek MA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA., Mohammaden MH; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA., Haussen DC; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA., Dolia JN; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: jdolia@emory.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Jul; Vol. 33 (7), pp. 107760. Date of Electronic Publication: 2024 May 07.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107760
Abstrakt: Background: Carotid free-floating thrombus (CFT) is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by flow on vascular imaging. Unfortunately, there is no clear consensus among experts on the ideal treatment for this pathology.
Methods: Retrospective analysis of acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients diagnosed with CFT on computed tomography angiogram (CTA) between January 2015-March 2023. We aimed to compare two treatment regimens: anticoagulation (ACT) and antiplatelet (APT) in the treatment of CFT. APT regimens included the use of dual or single antiplatelets (DAPT or SAPT; aspirin, clopidogrel and ticagrelor) and ACT regimens included the use of direct oral anticoagulants, warfarin, heparin or low molecular weight heparin +/- ASA. Patients that underwent mechanical thrombectomy were excluded.
Results: During study time there were 8252 acute ischemic stroke hospitalizations, of which 135 (1.63 %) patients were diagnosed with CFT. Sixty-six patients were included in our analysis. Patients assigned to APT were older (60.41years ± 12.82;p < 0.01). Other demographic variables were similar between ACT and APT groups. Complete CFT resolution on repeat vascular imaging was numerically higher at 30 days (58.8 vs 31.6 %, respectively; p = 0.1) and at latest follow-up (70.8 vs 50 %; p = 0.1) on ACT vs APT, respectively without reaching statistical significance. Similarly, there was numerically higher rates of any ICH with ACT compared to APT but it did not achieve statistical significance (27.6 % vs 13.5 %; p = 0.5). There were similar rates of PH1/2 hemorrhagic transformation, independence at discharge and similar hospital length of stay between ACT and APT groups. Patients assigned to APT were more likely to be discharged on their assigned treatment compared to those assigned to ACT (86.5 vs 55.2 %; p < 0.001). The rate of 30-day recurrent stroke was comparable among ACT and APT at 30 days (3.4 vs 0 %; p = 0.1, respectively). Subgroup analysis comparing exclusive ACT vs Dual APT lead to similar results.
Conclusion: Our study showed comparable efficacy and safety outcomes in CFT patients who were exclusively managed medically with ACT vs APT. Larger prospective studies are needed.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: