Antiplatelet and anticoagulant therapy confer similar benefit for cervical artery dissection

The Lancet Neurology

Extracranial carotid and vertebral artery dissection is a significant etiology of stroke in young people.  Antiplatelet and anticoagulants are commonly prescribed to reduce the risk of recurrent stroke, but the optimal therapy is unclear.  At 39 stroke centers in the UK and Australia, patients with dissections with onset of symptoms within 7 days were randomly assigned to antiplatelet or anticoagulant therapy in the Cervical Artery Dissection in Stroke Study (CADISS).  250 participants (118 carotid, 132 vertebral) received antiplatelet treatment (N=126) or anticoagulation (N=124). Major presenting symptoms were stroke or transient ischemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26).  In 3 months of follow-up, stroke or death occurred in three of 126 patients (2%) receiving antiplatelet therapy versus one of 124 (1%) receiving anticoagulation (OR=0.335, 95% CI 0.006-4.233; p=0.63). There were no deaths, but one major subarachnoid hemorrhage occurred in the anticoagulant group.  The authors conclude that there was no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection. Stroke was rare in both groups and much rarer than reported in some observational studies.  Further long-term follow up is indicated.

Robert M. Starke, MD MSC
Charlottesville, VA