Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Shadi Yaghi; Liqi Shu; Daniel Mandel; Christopher R. Leon Guerrero; Nils Henninger; Jayachandra Muppa; Muhammad Affan; Omair Ul Haq Lodhi; Mirjam R. Heldner; Kateryna Antonenko; David Seiffge; Marcel Arnold; Setareh Salehi Omran; Ross Crandall; Evan Lester; Diego Lopez Mena; Antonio Arauz; Ahmad Nehme; Marion Boulanger; Emmanuel Touze; Joao Andre Sousa; Joao Sargento-Freitas; Vasco Barata; Paulo Castro-Chaves; Maria Teresa Brito; Muhib Khan; Dania Mallick; Aaron Rothstein; Ossama Khazaal; Josefin E. Kaufmann; Stefan T. Engelter; Christopher Traenka; Diana Aguiar De Sousa; Mafalda Soares; Sara Rosa; Lily W. Zhou; Preet Gandhi; Thalia S. Field; Steven Mancini; Issa Metanis; Ronen R. Leker; Kelly Pan; Vishnu Dantu; Karl Baumgartner; Tina Burton; Regina Von Rennenberg; Christian H. Nolte; Richard Choi; Jason Macdonald; Reza Bavarsad Shahripour; Xiaofan Guo; Malik Ghannam; Mohammad Almajali; Edgar A. Samaniego; Sebastian Sanchez; Bastien Rioux; Faycal Zine-Eddine; Alexandre Poppe; Ana Catarina Fonseca; Maria Fortuna Baptista; Diana Cruz; Michele Romoli; Giovanna De Marco; Marco Longoni; Zafer Keser; Kim Griffin; Lindsey Kuohn; Jennifer Frontera; Jordan Amar; James Giles; Marialuisa Zedde; Rosario Pascarella; Ilaria Grisendi; Hipolito Nzwalo; David S. Liebeskind; Amir Molaie; Annie Cavalier; Wayneho Kam; Brian Mac Grory; Sami Al Kasab; Mohammad Anadani; Kimberly Kicielinski; Ali Eltatawy; Lina Chervak; Roberto Chulluncuy-Rivas; Yasmin Aziz; Ekaterina Bakradze; Thanh Lam Tran; Marc Rodrigo-Gisbert; Manuel Requena; Faddi Saleh Velez; Jorge Ortiz Gracia; Varsha Mudassani; Adam De Havenon; Venugopalan Y. Vishnu; Sridhara Yaddanapudi; Latasha Adams; Abigail Browngoehl; Tamra Ranasinghe; Randy Dunston; Zachary Lynch; Mary Penckofer; James Siegler; Silvia Mayer; Joshua Willey; Adeel Zubair; Yee Kuang Cheng; Richa Sharma; João Pedro Marto; Vítor Mendes Ferreira; Piers Klein; Thanh N. Nguyen; Syed Daniyal Asad; Zoha Sarwat; Anvesh Balabhadra; Shivam Patel; Thais Secchi; Sheila Martins; Gabriel Mantovani; Young Dae Kim; Balaji Krishnaiah; Cheran Elangovan; Sivani Lingam; Abid Quereshi; Sebastian Fridman; Alonso Alvarado; Farid Khasiyev; Guillermo Linares; Marina Mannino; Valeria Terruso; Sofia Vassilopoulou; Vasilis Tentolouris; Manuel Martinez-Marino; Victor Carrasco Wall; Fransisca Indraswari; Sleiman El Jamal; Shilin Liu; Muhammad Alvi; Farman Ali; Mohammed Sarvath; Rami Z. Morsi; Tareq Kass-Hout; Feina Shi; Jinhua Zhang; Dilraj Sokhi; Jamil Said; Alexis N. Simpkins; Roberto Gomez; Shayak Sen; Mohammad Ghani; Marwa Elnazeir; Han Xiao; Narendra Kala; Farhan Khan; Christoph Stretz; Nahid Mohammadzadeh; Eric Goldstein; Karen Furie

doi:10.1161/STROKEAHA.123.045731

Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

Shadi Yaghi, Liqi Shu, Daniel Mandel, Christopher R. Leon Guerrero, Nils Henninger, Jayachandra Muppa, Muhammad Affan, Omair Ul Haq Lodhi, Mirjam R. Heldner, Kateryna Antonenko, David Seiffge, Marcel Arnold, Setareh Salehi Omran, Ross Crandall, Evan Lester, Diego Lopez Mena, Antonio Arauz, Ahmad Nehme, Marion Boulanger, Emmanuel TouzeJoao Andre Sousa, Joao Sargento-Freitas, Vasco Barata, Paulo Castro-Chaves, Maria Teresa Brito, Muhib Khan, Dania Mallick, Aaron Rothstein, Ossama Khazaal, Josefin E. Kaufmann, Stefan T. Engelter, Christopher Traenka, Diana Aguiar De Sousa, Mafalda Soares, Sara Rosa, Lily W. Zhou, Preet Gandhi, Thalia S. Field, Steven Mancini, Issa Metanis, Ronen R. Leker, Kelly Pan, Vishnu Dantu, Karl Baumgartner, Tina Burton, Regina Von Rennenberg, Christian H. Nolte, Richard Choi, Jason Macdonald, Reza Bavarsad Shahripour, Xiaofan Guo, Malik Ghannam, Mohammad Almajali, Edgar A. Samaniego, Sebastian Sanchez, Bastien Rioux, Faycal Zine-Eddine, Alexandre Poppe, Ana Catarina Fonseca, Maria Fortuna Baptista, Diana Cruz, Michele Romoli, Giovanna De Marco, Marco Longoni, Zafer Keser, Kim Griffin, Lindsey Kuohn, Jennifer Frontera, Jordan Amar, James Giles, Marialuisa Zedde, Rosario Pascarella, Ilaria Grisendi, Hipolito Nzwalo, David S. Liebeskind, Amir Molaie, Annie Cavalier, Wayneho Kam, Brian Mac Grory, Sami Al Kasab, Mohammad Anadani, Kimberly Kicielinski, Ali Eltatawy, Lina Chervak, Roberto Chulluncuy-Rivas, Yasmin Aziz, Ekaterina Bakradze, Thanh Lam Tran, Marc Rodrigo-Gisbert, Manuel Requena, Faddi Saleh Velez, Jorge Ortiz Gracia, Varsha Mudassani, Adam De Havenon, Venugopalan Y. Vishnu, Sridhara Yaddanapudi, Latasha Adams, Abigail Browngoehl, Tamra Ranasinghe, Randy Dunston, Zachary Lynch, Mary Penckofer, James Siegler, Silvia Mayer, Joshua Willey, Adeel Zubair, Yee Kuang Cheng, Richa Sharma, João Pedro Marto, Vítor Mendes Ferreira, Piers Klein, Thanh N. Nguyen, Syed Daniyal Asad, Zoha Sarwat, Anvesh Balabhadra, Shivam Patel, Thais Secchi, Sheila Martins, Gabriel Mantovani, Young Dae Kim, Balaji Krishnaiah, Cheran Elangovan, Sivani Lingam, Abid Quereshi, Sebastian Fridman, Alonso Alvarado, Farid Khasiyev, Guillermo Linares, Marina Mannino, Valeria Terruso, Sofia Vassilopoulou, Vasilis Tentolouris, Manuel Martinez-Marino, Victor Carrasco Wall, Fransisca Indraswari, Sleiman El Jamal, Shilin Liu, Muhammad Alvi, Farman Ali, Mohammed Sarvath, Rami Z. Morsi, Tareq Kass-Hout, Feina Shi, Jinhua Zhang, Dilraj Sokhi, Jamil Said, Alexis N. Simpkins, Roberto Gomez, Shayak Sen, Mohammad Ghani, Marwa Elnazeir, Han Xiao, Narendra Kala, Farhan Khan, Christoph Stretz, Nahid Mohammadzadeh, Eric Goldstein, Karen Furie

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-Treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; P^interaction=0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.

Original language	English
Pages (from-to)	908-918
Number of pages	11
Journal	Stroke
Volume	55
Issue number	4
DOIs	https://doi.org/10.1161/STROKEAHA.123.045731
Publication status	Published - 1 Apr 2024
Externally published	Yes

Keywords

anticoagulants
arteries
hemorrhage
ischemic stroke
stroke

Access to Document

10.1161/STROKEAHA.123.045731

Cite this

Yaghi, S., Shu, L., Mandel, D., Leon Guerrero, C. R., Henninger, N., Muppa, J., Affan, M., Ul Haq Lodhi, O., Heldner, M. R., Antonenko, K., Seiffge, D., Arnold, M., Salehi Omran, S., Crandall, R., Lester, E., Lopez Mena, D., Arauz, A., Nehme, A., Boulanger, M., ... Furie, K. (2024). Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study. Stroke, 55(4), 908-918. https://doi.org/10.1161/STROKEAHA.123.045731

@article{81711183751f47b3864a99620a00e2c7,

title = "Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study",

abstract = "BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-Treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; Pinteraction=0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.",

keywords = "anticoagulants, arteries, hemorrhage, ischemic stroke, stroke",

author = "Shadi Yaghi and Liqi Shu and Daniel Mandel and {Leon Guerrero}, {Christopher R.} and Nils Henninger and Jayachandra Muppa and Muhammad Affan and {Ul Haq Lodhi}, Omair and Heldner, {Mirjam R.} and Kateryna Antonenko and David Seiffge and Marcel Arnold and {Salehi Omran}, Setareh and Ross Crandall and Evan Lester and {Lopez Mena}, Diego and Antonio Arauz and Ahmad Nehme and Marion Boulanger and Emmanuel Touze and Sousa, {Joao Andre} and Joao Sargento-Freitas and Vasco Barata and Paulo Castro-Chaves and Brito, {Maria Teresa} and Muhib Khan and Dania Mallick and Aaron Rothstein and Ossama Khazaal and Kaufmann, {Josefin E.} and Engelter, {Stefan T.} and Christopher Traenka and {Aguiar De Sousa}, Diana and Mafalda Soares and Sara Rosa and Zhou, {Lily W.} and Preet Gandhi and Field, {Thalia S.} and Steven Mancini and Issa Metanis and Leker, {Ronen R.} and Kelly Pan and Vishnu Dantu and Karl Baumgartner and Tina Burton and {Von Rennenberg}, Regina and Nolte, {Christian H.} and Richard Choi and Jason Macdonald and {Bavarsad Shahripour}, Reza and Xiaofan Guo and Malik Ghannam and Mohammad Almajali and Samaniego, {Edgar A.} and Sebastian Sanchez and Bastien Rioux and Faycal Zine-Eddine and Alexandre Poppe and Fonseca, {Ana Catarina} and Baptista, {Maria Fortuna} and Diana Cruz and Michele Romoli and {De Marco}, Giovanna and Marco Longoni and Zafer Keser and Kim Griffin and Lindsey Kuohn and Jennifer Frontera and Jordan Amar and James Giles and Marialuisa Zedde and Rosario Pascarella and Ilaria Grisendi and Hipolito Nzwalo and Liebeskind, {David S.} and Amir Molaie and Annie Cavalier and Wayneho Kam and {Mac Grory}, Brian and {Al Kasab}, Sami and Mohammad Anadani and Kimberly Kicielinski and Ali Eltatawy and Lina Chervak and Roberto Chulluncuy-Rivas and Yasmin Aziz and Ekaterina Bakradze and Tran, {Thanh Lam} and Marc Rodrigo-Gisbert and Manuel Requena and {Saleh Velez}, Faddi and {Ortiz Gracia}, Jorge and Varsha Mudassani and {De Havenon}, Adam and Vishnu, {Venugopalan Y.} and Sridhara Yaddanapudi and Latasha Adams and Abigail Browngoehl and Tamra Ranasinghe and Randy Dunston and Zachary Lynch and Mary Penckofer and James Siegler and Silvia Mayer and Joshua Willey and Adeel Zubair and Cheng, {Yee Kuang} and Richa Sharma and Marto, {Jo{\~a}o Pedro} and {Mendes Ferreira}, V{\'i}tor and Piers Klein and Nguyen, {Thanh N.} and Asad, {Syed Daniyal} and Zoha Sarwat and Anvesh Balabhadra and Shivam Patel and Thais Secchi and Sheila Martins and Gabriel Mantovani and Kim, {Young Dae} and Balaji Krishnaiah and Cheran Elangovan and Sivani Lingam and Abid Quereshi and Sebastian Fridman and Alonso Alvarado and Farid Khasiyev and Guillermo Linares and Marina Mannino and Valeria Terruso and Sofia Vassilopoulou and Vasilis Tentolouris and Manuel Martinez-Marino and {Carrasco Wall}, Victor and Fransisca Indraswari and {El Jamal}, Sleiman and Shilin Liu and Muhammad Alvi and Farman Ali and Mohammed Sarvath and Morsi, {Rami Z.} and Tareq Kass-Hout and Feina Shi and Jinhua Zhang and Dilraj Sokhi and Jamil Said and Simpkins, {Alexis N.} and Roberto Gomez and Shayak Sen and Mohammad Ghani and Marwa Elnazeir and Han Xiao and Narendra Kala and Farhan Khan and Christoph Stretz and Nahid Mohammadzadeh and Eric Goldstein and Karen Furie",

year = "2024",

month = apr,

day = "1",

doi = "10.1161/STROKEAHA.123.045731",

language = "English",

volume = "55",

pages = "908--918",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "4",

}

Yaghi, S, Shu, L, Mandel, D, Leon Guerrero, CR, Henninger, N, Muppa, J, Affan, M, Ul Haq Lodhi, O, Heldner, MR, Antonenko, K, Seiffge, D, Arnold, M, Salehi Omran, S, Crandall, R, Lester, E, Lopez Mena, D, Arauz, A, Nehme, A, Boulanger, M, Touze, E, Sousa, JA, Sargento-Freitas, J, Barata, V, Castro-Chaves, P, Brito, MT, Khan, M, Mallick, D, Rothstein, A, Khazaal, O, Kaufmann, JE, Engelter, ST, Traenka, C, Aguiar De Sousa, D, Soares, M, Rosa, S, Zhou, LW, Gandhi, P, Field, TS, Mancini, S, Metanis, I, Leker, RR, Pan, K, Dantu, V, Baumgartner, K, Burton, T, Von Rennenberg, R, Nolte, CH, Choi, R, Macdonald, J, Bavarsad Shahripour, R, Guo, X, Ghannam, M, Almajali, M, Samaniego, EA, Sanchez, S, Rioux, B, Zine-Eddine, F, Poppe, A, Fonseca, AC, Baptista, MF, Cruz, D, Romoli, M, De Marco, G, Longoni, M, Keser, Z, Griffin, K, Kuohn, L, Frontera, J, Amar, J, Giles, J, Zedde, M, Pascarella, R, Grisendi, I, Nzwalo, H, Liebeskind, DS, Molaie, A, Cavalier, A, Kam, W, Mac Grory, B, Al Kasab, S, Anadani, M, Kicielinski, K, Eltatawy, A, Chervak, L, Chulluncuy-Rivas, R, Aziz, Y, Bakradze, E, Tran, TL, Rodrigo-Gisbert, M, Requena, M, Saleh Velez, F, Ortiz Gracia, J, Mudassani, V, De Havenon, A, Vishnu, VY, Yaddanapudi, S, Adams, L, Browngoehl, A, Ranasinghe, T, Dunston, R, Lynch, Z, Penckofer, M, Siegler, J, Mayer, S, Willey, J, Zubair, A, Cheng, YK, Sharma, R, Marto, JP, Mendes Ferreira, V, Klein, P, Nguyen, TN, Asad, SD, Sarwat, Z, Balabhadra, A, Patel, S, Secchi, T, Martins, S, Mantovani, G, Kim, YD, Krishnaiah, B, Elangovan, C, Lingam, S, Quereshi, A, Fridman, S, Alvarado, A, Khasiyev, F, Linares, G, Mannino, M, Terruso, V, Vassilopoulou, S, Tentolouris, V, Martinez-Marino, M, Carrasco Wall, V, Indraswari, F, El Jamal, S, Liu, S, Alvi, M, Ali, F, Sarvath, M, Morsi, RZ, Kass-Hout, T, Shi, F, Zhang, J, Sokhi, D, Said, J, Simpkins, AN, Gomez, R, Sen, S, Ghani, M, Elnazeir, M, Xiao, H, Kala, N, Khan, F, Stretz, C, Mohammadzadeh, N, Goldstein, E & Furie, K 2024, 'Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study', Stroke, vol. 55, no. 4, pp. 908-918. https://doi.org/10.1161/STROKEAHA.123.045731

TY - JOUR

T1 - Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection

T2 - The STOP-CAD Study

AU - Yaghi, Shadi

AU - Shu, Liqi

AU - Mandel, Daniel

AU - Leon Guerrero, Christopher R.

AU - Henninger, Nils

AU - Muppa, Jayachandra

AU - Affan, Muhammad

AU - Ul Haq Lodhi, Omair

AU - Heldner, Mirjam R.

AU - Antonenko, Kateryna

AU - Seiffge, David

AU - Arnold, Marcel

AU - Salehi Omran, Setareh

AU - Crandall, Ross

AU - Lester, Evan

AU - Lopez Mena, Diego

AU - Arauz, Antonio

AU - Nehme, Ahmad

AU - Boulanger, Marion

AU - Touze, Emmanuel

AU - Sousa, Joao Andre

AU - Sargento-Freitas, Joao

AU - Barata, Vasco

AU - Castro-Chaves, Paulo

AU - Brito, Maria Teresa

AU - Khan, Muhib

AU - Mallick, Dania

AU - Rothstein, Aaron

AU - Khazaal, Ossama

AU - Kaufmann, Josefin E.

AU - Engelter, Stefan T.

AU - Traenka, Christopher

AU - Aguiar De Sousa, Diana

AU - Soares, Mafalda

AU - Rosa, Sara

AU - Zhou, Lily W.

AU - Gandhi, Preet

AU - Field, Thalia S.

AU - Mancini, Steven

AU - Metanis, Issa

AU - Leker, Ronen R.

AU - Pan, Kelly

AU - Dantu, Vishnu

AU - Baumgartner, Karl

AU - Burton, Tina

AU - Von Rennenberg, Regina

AU - Nolte, Christian H.

AU - Choi, Richard

AU - Macdonald, Jason

AU - Bavarsad Shahripour, Reza

AU - Guo, Xiaofan

AU - Ghannam, Malik

AU - Almajali, Mohammad

AU - Samaniego, Edgar A.

AU - Sanchez, Sebastian

AU - Rioux, Bastien

AU - Zine-Eddine, Faycal

AU - Poppe, Alexandre

AU - Fonseca, Ana Catarina

AU - Baptista, Maria Fortuna

AU - Cruz, Diana

AU - Romoli, Michele

AU - De Marco, Giovanna

AU - Longoni, Marco

AU - Keser, Zafer

AU - Griffin, Kim

AU - Kuohn, Lindsey

AU - Frontera, Jennifer

AU - Amar, Jordan

AU - Giles, James

AU - Zedde, Marialuisa

AU - Pascarella, Rosario

AU - Grisendi, Ilaria

AU - Nzwalo, Hipolito

AU - Liebeskind, David S.

AU - Molaie, Amir

AU - Cavalier, Annie

AU - Kam, Wayneho

AU - Mac Grory, Brian

AU - Al Kasab, Sami

AU - Anadani, Mohammad

AU - Kicielinski, Kimberly

AU - Eltatawy, Ali

AU - Chervak, Lina

AU - Chulluncuy-Rivas, Roberto

AU - Aziz, Yasmin

AU - Bakradze, Ekaterina

AU - Tran, Thanh Lam

AU - Rodrigo-Gisbert, Marc

AU - Requena, Manuel

AU - Saleh Velez, Faddi

AU - Ortiz Gracia, Jorge

AU - Mudassani, Varsha

AU - De Havenon, Adam

AU - Vishnu, Venugopalan Y.

AU - Yaddanapudi, Sridhara

AU - Adams, Latasha

AU - Browngoehl, Abigail

AU - Ranasinghe, Tamra

AU - Dunston, Randy

AU - Lynch, Zachary

AU - Penckofer, Mary

AU - Siegler, James

AU - Mayer, Silvia

AU - Willey, Joshua

AU - Zubair, Adeel

AU - Cheng, Yee Kuang

AU - Sharma, Richa

AU - Marto, João Pedro

AU - Mendes Ferreira, Vítor

AU - Klein, Piers

AU - Nguyen, Thanh N.

AU - Asad, Syed Daniyal

AU - Sarwat, Zoha

AU - Balabhadra, Anvesh

AU - Patel, Shivam

AU - Secchi, Thais

AU - Martins, Sheila

AU - Mantovani, Gabriel

AU - Kim, Young Dae

AU - Krishnaiah, Balaji

AU - Elangovan, Cheran

AU - Lingam, Sivani

AU - Quereshi, Abid

AU - Fridman, Sebastian

AU - Alvarado, Alonso

AU - Khasiyev, Farid

AU - Linares, Guillermo

AU - Mannino, Marina

AU - Terruso, Valeria

AU - Vassilopoulou, Sofia

AU - Tentolouris, Vasilis

AU - Martinez-Marino, Manuel

AU - Carrasco Wall, Victor

AU - Indraswari, Fransisca

AU - El Jamal, Sleiman

AU - Liu, Shilin

AU - Alvi, Muhammad

AU - Ali, Farman

AU - Sarvath, Mohammed

AU - Morsi, Rami Z.

AU - Kass-Hout, Tareq

AU - Shi, Feina

AU - Zhang, Jinhua

AU - Sokhi, Dilraj

AU - Said, Jamil

AU - Simpkins, Alexis N.

AU - Gomez, Roberto

AU - Sen, Shayak

AU - Ghani, Mohammad

AU - Elnazeir, Marwa

AU - Xiao, Han

AU - Kala, Narendra

AU - Khan, Farhan

AU - Stretz, Christoph

AU - Mohammadzadeh, Nahid

AU - Goldstein, Eric

AU - Furie, Karen

PY - 2024/4/1

Y1 - 2024/4/1

N2 - BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-Treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; Pinteraction=0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.

AB - BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-Treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; Pinteraction=0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.

KW - anticoagulants

KW - arteries

KW - hemorrhage

KW - ischemic stroke

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85187724714&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.123.045731

DO - 10.1161/STROKEAHA.123.045731

M3 - Article

C2 - 38335240

AN - SCOPUS:85187724714

SN - 0039-2499

VL - 55

SP - 908

EP - 918

JO - Stroke

JF - Stroke

IS - 4

ER -

Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study

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