Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis

Fiona Kennedy, Silvia Lanfranconi, Cara Hicks, John Reid, Patrick Gompertz, Christopher Price, Sally Kerry, John Norris, Hugh S. Markus

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Abstract

Objective: To present the results of the nonrandomized arm of the Cervical Artery Dissection in Stroke Study (CADISS-NR) trial, comparing anticoagulation and antiplatelets for prevention of recurrent stroke after carotid and vertebral dissection, and perform a meta-analysis of these results with previously published studies comparing the 2 therapeutic strategies. Methods: A total of 88 patients from 22 centers with extracranial carotid and vertebral dissection were recruited within 1 month of symptom onset. The primary endpoint was recurrent stroke at 3 months. A systematic review was performed, and results of published studies included in a metaanalysis with the CADISS-NR results. Results: In CADISS-NR, one patient in each group had recurrent ischemic stroke (antiplatelet 1/59 [1.69%], anticoagulation 1/28 [3.57%]). At the primary endpoint of 3 months, 3 (5.08%) antiplatelet patients had recurrent TIA, compared with none in the anticoagulation group. For metaanalysis, there were data from 40 nonrandomized studies including 1,636 patients. There was no significant difference between the 2 treatments in recurrent stroke risk (antiplatelet 13/499 [2.6%], anticoagulant 20/1,137 [1.8%], odds ratio [OR] 1.49) or risk of death (antiplatelet 5/499 [1.00%], anticoagulant 9/1,137 [0.80%], OR 1.27). Conclusion: There is no evidence for superiority of anticoagulation or antiplatelet therapy in prevention of stoke after carotid and vertebral artery dissection; however, all data are from nonrandomized studies and randomized studies are required. The nonrandomized CADISS data show a lower rate of recurrent stroke than reported in some previous studies. Clinical Trial Registration Information: www.dissection.co.uk, ISRNCTN44555237.

Original languageEnglish
Pages (from-to)686-689
Number of pages4
JournalNeurology
Volume79
Issue number7
DOIs
Publication statusPublished - Aug 14 2012

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ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Kennedy, F., Lanfranconi, S., Hicks, C., Reid, J., Gompertz, P., Price, C., Kerry, S., Norris, J., & Markus, H. S. (2012). Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology, 79(7), 686-689. https://doi.org/10.1212/WNL.0b013e318264e36b