Introduction: Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients. Antiplatelet or anticoagulant agents are commonly used to minimize complications. There is paucity of evidence regarding which class of medications is most effective. The objective of this study is to review anticoagulation trends in patients with dissections of the carotid and vertebral arteries.

Methods: A review of electronic medical records was conducted. The search criteria included patients with the diagnosis of carotid and vertebral dissection. 370 patients were identified. Baseline patient characteristics, treatments and clinical follow-up for recurrent transient ischemic attack and recurrent stroke were recorded.

Results: Mean follow up period was 24.25 months. 28.4% of patients had a history of trauma. 35.7% of dissections occurred in the vertebral artery, 59.7% in the internal carotid artery and 4.6% in both. 11% of dissections were intracranial, 9.2% were extracranial with intracranial extension and 79.7% were extracranial. 55.9% of patients were started on antiplatelet therapy, 27% were started on anticoagulation and 11.9% were started on a combined regimen. Recurrent stroke was observed in 2.7%, recurrent TIA was recorded in 5.4% and recurrent intracerebral hemorrhage was seen in 2.16%. Recurrent stroke occurred in 2.9% of patients who were started on antiplatelets, 2% of patients on anticoagulation and 4.5% in patients on combined treatment. Recurrent TIA was seen in 4.3% of patients on antiplatelet treatment, 7% of patients on anticoagulation and 9% on combined. Recurrent hemorrhage was seen in 1.9 % of patients on antiplatelets, 2% on anticoagulation and 4.5% on combined. Mean time to recurrent event was 26.2 months. 12.7% of patients required an endovascular or surgical intervention to manage the dissection.

Conclusions: The rates of recurrent stroke, TIA and hemorrhage are similar with the use of antiplatelet treatment and anticoagulation in the management of carotid and vertebral artery dissection.

Patient Care: It will add to the literature important knowledge about the different treatments used in the management of vessel dissections

Learning Objectives: To review the different treatments used in the management of carotid and vertebral dissections and to identify any differences in outcome between anti-platelet and anti-coagulation treatment.

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