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Review
. 2021 Jan-Dec:27:10760296211051708.
doi: 10.1177/10760296211051708.

Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials

Sheng-Lin Ye  1 , Chuang Wang  1 , Lu-Lu Wang  1 , Tian-Ze Xu  1 , Xiao-Qiang Li  1 , Tao Tang  1
Affiliations
Review

Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials

Sheng-Lin Ye et al. Clin Appl Thromb Hemost. 2021 Jan-Dec.

Abstract

Carotid and vertebral artery dissections are estimated to account for ∼20% of strokes in patients under 45-years-old. This meta-analysis compared the efficacy and safety of treatment with anticoagulants versus antiplatelet agents to determine the optimal therapy. We searched 4 electronic databases for clinical trials published from January 1, 1980 to August 25, 2021 that included patients who received anticoagulant or antiplatelet therapy for carotid and/or vertebral artery dissections. The curative effect was judged by recanalization evaluated by imaging. The primary outcomes were all cause death and ischemic stroke; secondary outcomes included hemorrhage and transient ischemic attack (TIA). Patients who received only a single drug treatment were divided into antiplatelet or anticoagulant groups; all received conservative treatment without surgical intervention. For this investigation, we pooled the available studies to conduct a meta-analysis, which included 7 articles with 1126 patients. The curative effect of vascular recanalization was not significantly different between the 2 treatment groups (odds ratio [OR] = 0.913, 95% confidence interval [CI]: 0.611-1.365, P = .657); similarly, no significant differences were found regarding the primary outcomes all cause death (OR = 1.747, 95%CI: 0.202-15.079, P = .612) and ischemic stroke (OR = 2.289, 95%CI: 0.997-5.254, P = .051). Patients treated with anticoagulants were more likely to experience TIA (OR = 0.517, 95%CI: 0.252-1.060, P = .072) and hemorrhage (OR = 0.468, 95%CI: 0.210-1.042, P = .063), but the differences were not statistically significant. Overall, there were no statistically significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections.

Keywords: anticoagulant; antiplatelet; carotid artery dissection; stroke; vertebral artery dissection.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of literature review.
Figure 2.
Figure 2.
Meta-analysis of outcomes of clinical trials. (A) Meta-analysis of recanalization (OR = 0.913; 95%CI 0.611-1.365; P = .657). (B) Meta-analysis of death (OR = 1.747; 95%CI 0.202-15.079; P = .612). (C) Meta-analysis of ischemic stroke (OR = 2.289; 95%CI 0.997-5.254; P = .051). (D) Meta-analysis of hemorrhage (OR = 0.468; 95%CI 0.210-1.042; P = .063). (E) Meta-analysis of transient ischemic attack (OR = 0.517; 95%CI 0.252-1.060; P = .072).
Figure 2.
Figure 2.
Meta-analysis of outcomes of clinical trials. (A) Meta-analysis of recanalization (OR = 0.913; 95%CI 0.611-1.365; P = .657). (B) Meta-analysis of death (OR = 1.747; 95%CI 0.202-15.079; P = .612). (C) Meta-analysis of ischemic stroke (OR = 2.289; 95%CI 0.997-5.254; P = .051). (D) Meta-analysis of hemorrhage (OR = 0.468; 95%CI 0.210-1.042; P = .063). (E) Meta-analysis of transient ischemic attack (OR = 0.517; 95%CI 0.252-1.060; P = .072).
Figure 2.
Figure 2.
Meta-analysis of outcomes of clinical trials. (A) Meta-analysis of recanalization (OR = 0.913; 95%CI 0.611-1.365; P = .657). (B) Meta-analysis of death (OR = 1.747; 95%CI 0.202-15.079; P = .612). (C) Meta-analysis of ischemic stroke (OR = 2.289; 95%CI 0.997-5.254; P = .051). (D) Meta-analysis of hemorrhage (OR = 0.468; 95%CI 0.210-1.042; P = .063). (E) Meta-analysis of transient ischemic attack (OR = 0.517; 95%CI 0.252-1.060; P = .072).
Figure 2.
Figure 2.
Meta-analysis of outcomes of clinical trials. (A) Meta-analysis of recanalization (OR = 0.913; 95%CI 0.611-1.365; P = .657). (B) Meta-analysis of death (OR = 1.747; 95%CI 0.202-15.079; P = .612). (C) Meta-analysis of ischemic stroke (OR = 2.289; 95%CI 0.997-5.254; P = .051). (D) Meta-analysis of hemorrhage (OR = 0.468; 95%CI 0.210-1.042; P = .063). (E) Meta-analysis of transient ischemic attack (OR = 0.517; 95%CI 0.252-1.060; P = .072).
Figure 2.
Figure 2.
Meta-analysis of outcomes of clinical trials. (A) Meta-analysis of recanalization (OR = 0.913; 95%CI 0.611-1.365; P = .657). (B) Meta-analysis of death (OR = 1.747; 95%CI 0.202-15.079; P = .612). (C) Meta-analysis of ischemic stroke (OR = 2.289; 95%CI 0.997-5.254; P = .051). (D) Meta-analysis of hemorrhage (OR = 0.468; 95%CI 0.210-1.042; P = .063). (E) Meta-analysis of transient ischemic attack (OR = 0.517; 95%CI 0.252-1.060; P = .072).
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