Efficacy and safety of anticoagulant and antiplatelet therapies in the medical management of carotid free-floating thrombus: A systematic review.

Autor: Camerotte R; Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil., Vilardo M; School of Medicine, Catholic University of Brasilia, Brasília, DF, Brazil., Ribeiro FV; Faculty of Medicine, Barão de Mauá University Center, Ribeirão Preto, SP, Brazil., Bocanegra-Becerra JE; Academic Department of Surgery, School of Medicine, Univesidad Peruana Cayetano Heredia, Lima, Peru., Gonçalves OR; School of Medicine, Federal University of Piauí, Teresina, PI, Brazil., Paleare L; School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil., Dominici S; School of Medicine, Federal University of Maranhão, São Luís, MA, Brazil., Corvelo APC; Faculty of Medicine, University of Grande Rio, Duque de Caxias, RJ, Brazil., Fukunaga CK; Faculty of Medicine, FMABC University Center, São Paulo, SP, Brazil., Mitre LP; Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil., Sobral T; Faculty of Medicine, Cesmac University Center, Maceió, AL, Brazil., Ferreira MY; Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA., Ferreira C; Department of Neurosurgery, Phelps Hospital, Northwell Health, New York, NY, USA., Gordon D; Department of Neurosurgery, Phelps Hospital, Northwell Health, New York, NY, USA., Langer D; Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA., Serulle Y; Department of Neurosurgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Jazyk: angličtina
Zdroj: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2024 Dec 10, pp. 15910199241304164. Date of Electronic Publication: 2024 Dec 10.
DOI: 10.1177/15910199241304164
Abstrakt: Background: The optimal treatment for carotid free-floating thrombus (CFFT) remains uncertain due to limited evidence, with no randomized clinical trials and scarce guidelines, such as ESVS 2023, favoring conservative management. Anticoagulation (ACT) and antiplatelet (APT) therapies are emerging as promising alternatives to high-risk surgical interventions. This systematic review aimed to evaluate the safety and efficacy of ACT and APT therapies for CFFT.
Methods: A systematic search was performed across PubMed, Embase, Web of Science, and Cochrane databases. Safety and efficacy endpoints were assessed. A two-sample t -test compared baseline characteristics between groups, and a Chi-square test evaluated differences in categorical variables. Statistical significance was set at p  < 0.05. Data were analyzed using R 4.3.0 with the meta package v.7.0-0.
Results: Four studies met the inclusion criteria, involving 170 patients diagnosed with CFFT. The APT group included 96 patients (mean age 55.35 ± 13.52 years; 56.25% male), and the ACT group included 74 patients (mean age 58.57 ± 14.28 years; 51.35% male). Thrombus regression was slightly lower in APT (42%) compared to ACT (48%). Both groups showed similar rates of residual stenosis. Antiplatelet had fewer ischemic events within 30 days (none vs. 4% in ACT) and lower intracranial hemorrhage rates (3.3% vs. 5.4% in ACT) but higher mortality (6.3% vs. none in ACT).
Conclusion: Both ACT and APT are effective for managing CFFT, each with distinct efficacy and safety profiles. However, randomized trials are necessary to better assess these therapies in CFFT management.
Competing Interests: Data availability statementThis systematic review used data from previously published studies; therefore, all data and study materials are public domain. The review authors do not have patient-level data from the individual studies. Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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