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

Autor:	Kaufmann JE; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland., Harshfield EL; Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom., Gensicke H; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland., Wegener S; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, and University of Zurich, Switzerland., Michel P; Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland., Kägi G; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.; Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland., Nedeltchev K; Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland., Kellert L; Department of Neurology, Ludwig Maximilian University, Munich, Germany.; Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany., Rosenbaum S; Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark., Nolte CH; Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charite-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Healths at Charite, Charite-Universitätsmedizin Berlin, Berlin, Germany., Christensen H; Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark., Arnold M; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland., Lyrer P; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland., Levi C; Faculty of Health and Medicine, University of Newcastle, and John Hunter Hospital, Newcastle, Australia., Bath PM; Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom., Engelter ST; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland., Traenka C; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland.; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland., Markus HS; Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2024 Jun 01; Vol. 81 (6), pp. 630-637.
DOI:	10.1001/jamaneurol.2024.1141
Abstrakt:	Importance: 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. Objective: To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection. Data Sources: PubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023. Study Selection: 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. Data Extraction/synthesis: 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. Main Outcomes and Measures: 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. Results: 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). Conclusions and Relevance: 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.
Databáze:	MEDLINE
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