Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sihua Liu; Xiao Zhang; Xuesong Bai; Yutong Yang; Tao Wang; Xin Xu; Ran Xu; Long Li; Yao Feng; Kun Yang; Xue Wang; Xiaofan Guo; Jing Chen; Yan Ma; Liqun Jiao

doi:10.3389/fneur.2021.745106

Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Front Neurol. 2021 Nov 24:12:745106. doi: 10.3389/fneur.2021.745106. eCollection 2021.

Authors

Sihua Liu^{1

2

3}, Xiao Zhang^{1

2}, Xuesong Bai^{1

2}, Yutong Yang⁴, Tao Wang^{1

2}, Xin Xu^{1

2}, Ran Xu^{1

2}, Long Li^{1

2}, Yao Feng^{1

2}, Kun Yang⁵, Xue Wang⁶, Xiaofan Guo⁷, Jing Chen⁸, Yan Ma^{1

2}, Liqun Jiao^{1

2

9}

Affiliations

¹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
² China International Neuroscience Institute (China-INI), Beijing, China.
³ Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
⁴ Imperial College London, National Heart & Lung Institute, London, United Kingdom.
⁵ Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁶ Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁷ Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States.
⁸ Department of Neurology, Zhumadian Central Hospital, Henan, China.
⁹ Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Abstract

Objective: The optimal management for cervical artery dissection (CAD) is uncertain. This study aimed to summarize the current randomized controlled trials (RCTs) to compare the efficacy and safety of antiplatelet and anticoagulation therapies for CAD. Methods: A literature search was conducted in the major databases, such as MEDLINE, Embase, and the Cochrane Library. Only the RCTs comparing the antiplatelet and anticoagulation therapies for the patients with CAD were included. Combined estimates of the relative risk (RR) of antiplatelet vs. anticoagulation were analyzed. Heterogeneity was measured using the I ² statistical analysis. The analyses were performed in the intention-to-treat (ITT) and per-protocol (PP) population, respectively. Results: Two RCTs involving 444 patients in the ITT population and 370 patients in the PP population were included. The quality of studies was high overall. In the ITT population, compared with the patients in the anticoagulation group, the patients in the antiplatelet group showed a higher rate of ischemic stroke within 3 months (RR = 6.73 [95% CI, 1.22-37.15], I ² = 0%, P = 0.029). No difference between these two treatment groups was found for the outcomes of transient ischemic attack (RR = 0.37 [95% CI, 0.09-1.58], I ² = 0%, P = 0.181), intracranial hemorrhage (RR = 0.33 [95% CI, 0.01-7.98], I ² = 0%, P = 0.494), major extracranial bleeding (RR = 0.31 [95% CI, 0.01-7.60], I ² = 0%, P = 0.476), or the composite of these outcomes within 3 months. For the PP population, the results of the meta-analysis of outcomes between the antiplatelet and anticoagulation groups were consistent with the ITT population. Conclusions: Compared with the antiplatelet group, the anticoagulation group has a lower risk of ischemic stroke without increasing bleeding risk when treating CAD. Anticoagulation seems to be superior over the antiplatelet in treating CAD but needs to be further tested by specifying several issues, such as location, initial symptom types, and treatment protocols.

Keywords: anticoagulation; antiplatelet; cervical artery dissection; ischemic stroke; meta-analysis.

Publication types

Systematic Review