Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?

Giovanni Malferrari, Domenico Laterza, Franco Valzania, Daniela Monaco, Mauro Silingardi, Attilia Maria Pizzini

Research output: Contribution to journalArticle

Abstract

Antiplatelet agents and vitamin K antagonists (VKA) are usually used in the treatment of cervical (carotid or vertebral) artery dissections (CADs); however, data about the use of direct oral anticoagulants (DOACs) in these conditions are very limited. DOACs have proven to be effective in stroke reduction in non-valvular atrial fibrillation and, when possible, they are preferred to warfarin because of their better safety profile. We describe four cases of CADs and, firstly in literature, cervico-cerebral (CCADs) in young patients (average age of 42 years) treated with rivaroxaban 20 mg daily. Three of these four dissections had affected the vertebral artery (condition with an unfavorable prognosis and more often complicated by subarachnoid hemorrhages), and the other one was a carotid dissection at the extra-intracranial passage. All patients were followed clinically and with serial neurosonological examinations at 1, 3, and 6 months and with magnetic resonance angiography (MRA) at 6 months. All patients presented a good outcome with vascular recanalization without stroke recurrence or bleedings, even in patients with intracranial vertebral artery involvement. DOACs could be an alternative in young patients with CADs and their use could be considered in intracranial artery dissections too.

Original languageEnglish
JournalNeurological Sciences
DOIs
Publication statusPublished - Jan 1 2019

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Cerebral Arteries
Vertebral Artery Dissection
Dissection
Anticoagulants
Vertebral Artery
Stroke
Therapeutics
Vitamin K
Magnetic Resonance Angiography
Platelet Aggregation Inhibitors
Warfarin
Subarachnoid Hemorrhage
Atrial Fibrillation
Blood Vessels
Arteries
Rivaroxaban
Hemorrhage
Safety
Recurrence

Keywords

  • Cervical and cervico-cerebral artery dissections
  • DOACs
  • Neurosonology
  • Rivaroxaban
  • Stroke
  • Transcranial color Doppler

ASJC Scopus subject areas

  • Dermatology
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Rivaroxaban in cervical and “cervico-cerebral” artery dissections : a new therapeutic option? / Malferrari, Giovanni; Laterza, Domenico; Valzania, Franco; Monaco, Daniela; Silingardi, Mauro; Pizzini, Attilia Maria.

In: Neurological Sciences, 01.01.2019.

Research output: Contribution to journalArticle

Malferrari, Giovanni ; Laterza, Domenico ; Valzania, Franco ; Monaco, Daniela ; Silingardi, Mauro ; Pizzini, Attilia Maria. / Rivaroxaban in cervical and “cervico-cerebral” artery dissections : a new therapeutic option?. In: Neurological Sciences. 2019.
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