Antiplatelets Versus Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-analysis of 2064 Patients

Background and Objectives In young people aged 3-month mortality (OR 1.63, 95% CI 0.40–6.56), recurrent stroke (OR 0.97, 95% CI 0.46–2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44–1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12–1.19), and complete r...

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Bibliographic Details
Published in:Drugs in R&D 2022-09, Vol.22 (3), p.187-203
Main Authors: Hagrass, Abdulrahman Ibrahim, Almaghary, Bashar Khaled, Mostafa, Mohamed Abdelhady, Elfil, Mohamed, Elsayed, Sarah Makram, Aboali, Amira A., Hamdallah, Aboalmagd, Hasan, Mohammed Tarek, Al-kafarna, Mohammed, Ragab, Khaled Mohamed, Doheim, Mohamed Fahmy
Format: Article
Language:English
Subjects:
Adolescent
Anticoagulants - adverse effects
Arteries
Humans
Internal Medicine
Ischemic Stroke
Medicine
Medicine & Public Health
Observational Studies as Topic
Pharmacology/Toxicology
Pharmacotherapy
Platelet Aggregation Inhibitors - adverse effects
Stroke - drug therapy
Stroke - etiology
Stroke - prevention & control
Systematic Review
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Summary:Background and Objectives In young people aged 3-month mortality (OR 1.63, 95% CI 0.40–6.56), recurrent stroke (OR 0.97, 95% CI 0.46–2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44–1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12–1.19), and complete recanalization (OR 0.70, 95% CI 0.46–1.06). Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs (OR 6.97, 95% CI 1.25–38.83). Conclusion Our study did not show a considerable difference between the two groups, as all outcomes showed non-significant differences between them, except for primary ischaemic stroke (RCTs) and complete recanalization (observational studies), which showed a significant favour of AC over AP. Even though primary ischaemic stroke is an important outcome, several crucial points that could affect these results should be paid attention to. These include the incomplete adjustment for the confounding effect of AP–AC doses, frequencies, administration compliance, and others. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CeAD.
ISSN:1174-5886
1179-6901
1179-6901
DOI:10.1007/s40268-022-00398-z