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Meta-Analysis
. 2022 Sep;22(3):187-203.
doi: 10.1007/s40268-022-00398-z. Epub 2022 Aug 3.

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

Abdulrahman Ibrahim Hagrass  1 , Bashar Khaled Almaghary  2 , Mohamed Abdelhady Mostafa  3 , Mohamed Elfil  4 , Sarah Makram Elsayed  5 , Amira A Aboali  6 , Aboalmagd Hamdallah  7 , Mohammed Tarek Hasan  1 , Mohammed Al-Kafarna  2 , Khaled Mohamed Ragab  8 , Mohamed Fahmy Doheim  9
Affiliations
Meta-Analysis

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

Abdulrahman Ibrahim Hagrass et al. Drugs R D. 2022 Sep.

Abstract

Background and objectives: In young people aged < 50 years, cervical artery dissection (CeAD) is among the most common causes of stroke. Currently, there is no consensus regarding the safest and most effective antithrombotic treatment for CeAD. We aimed to synthesize concrete evidence from studies that compared the efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for CeAD.

Methods: We searched major electronic databases/search engines from inception till September 2021. Cohort studies and randomized controlled trials (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A meta-analysis was conducted using articles that were obtained and found to be relevant. Mean difference (MD) with 95% confidence interval (CI) was used for continuous data and odds ratio (OR) with 95% CI for dichotomous data.

Results: Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Our analysis showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 95% CI 0.03-7.58), > 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.

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Conflict of interest statement

Abdulrahman Ibrahim Hagrass, Bashar Khaled Almaghary, Mohamed Abdelhady Mostafa, Mohamed Elfil, Sarah Makram Elsayed, Amira A. Aboali, Aboalmagd Hamdallah, Mohammed Tarek Hasan, Mohammed Al-kafarna, Khaled Mohamed Ragab and Mohamed Fahmy Doheim declare that they have no potential conflicts of interest that might be relevant to the content of this article.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias graph and summary
Fig. 3
Fig. 3
a Death during short-term follow-up. b Death during long-term follow-up
Fig. 4
Fig. 4
a Forest plot of primary ischaemic stroke. b Forest plot of primary transient ischaemic attack (TIA)
Fig. 5
Fig. 5
a Forest plot of recurrent stroke. b Forest plot of recurrent transient ischaemic attack (TIA)
Fig. 6
Fig. 6
a Forest plot of symptomatic Intracranial haemorrhage (ICH). b Forest plot of major extra-cranial bleeding
Fig. 7
Fig. 7
a Forest plot of good functional outcome at 6 months (mRs = 0–2). b Forest plot of poor outcome at 6 months (mRs ≥ 3)
See this image and copyright information in PMC

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