Antiplatelets Versus Anticoagulation For the Treatment of Cervical Artery Dissection: Shadi Yaghi, MD

WATCH TIME: 8 minutes

"Our study brings us closer to an answer on which treatment is better for each patient in cervical artery dissection, emphasizing the need for individualized approaches."

Cervical artery dissection (CAD) arises from vessel wall injury, potentially leading to intraluminal thrombus or steno-occlusion, which then heightens the risk of ischemic strokes.¹ Although the use of antithrombotic treatment has become pivotal for stroke prevention in patients who experience CAD, findings from research are limited. This is observed from undersized randomized trials that compared anticoagulation to antiplatelet therapy which have yielded inconclusive outcomes.² In the backdrop of research that lacks the evidence of definitively establishing superiority of one treatment approach over another, a state of clinical equipoise persists.

Presented at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, by lead author Shadi Yaghi, MD, and colleagues, new data from the STOP-CAD study showed the benefit of anticoagulation treatment over antiplatelets in reducing ischemic stroke risk, particularly with occlusive dissection, in patients with CAD.¹ Among 3636 patients with CAD in the study, 402 (11.1%) received exclusively anticoagulation and 2453 (67.5%) received exclusively antiplatelets. By day 180 of treatment with either anticoagulation or antiplatelets, investigators reported 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%).

In total, 87.0% of experienced ischemic strokes occurred within 30 days of treatment. In adjusted Cox regression with adjusted Cox regression with Inverse Probability of Treatment Weighting (IPTW) analysis, investigators observed anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted HR, 0.71; 95% CI, 0.45-1.12; P = .145) and by day 180 (adjusted HR, 0.80; 95% CI, 0.28-2.24; P = .670) compared with antiplatelet therapy.

Yaghi, associate professor of neurology, and division chief, vascular neurology, the Warren Alpert Medical School, Brown University, sat down with NeurologyLive® during the meeting to discuss ischemic strokes that CADs contribute to, and how this risk varies among different age groups. He also talked about how findings from another trial impact the understanding of aspirin compared with vitamin K antagonists in treating CAD. In addition, he shared the key findings that emerged from the observational study regarding the risks of ischemic strokes and major bleeding in patients receiving antiplatelet therapy versus anticoagulation.

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REFERENCES
1. Béjot Y, Daubail B, Debette S, Durier J, Giroud M. Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry. Int J Stroke. 2014;9(7):879-882. doi:10.1111/ijs.12154
2. Markus HS, Levi C, King A, Madigan J, Norris J; Cervical Artery Dissection in Stroke Study (CADISS) Investigators. Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection: The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results. JAMA Neurol. 2019;76(6):657-664. doi:10.1001/jamaneurol.2019.0072
3. Shadi Yaghi, Liqi Shu, Daniel M Mandel,, et al. Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study. Presented at: International Stroke Conference; February 7-9, 2024; Abstract LB30. Accessed February 21, 2024. https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.123.045731