Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?

Malferrari, Giovanni; Laterza, Domenico; Valzania, Franco; Monaco, Daniela; Silingardi, Mauro; Pizzini, Attilia Maria

doi:10.1007/s10072-019-03882-8

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Recently, in small case series, direct oral anticoagulants had been used in CAD-patients. [34][35][36][37] In general, direct oral anticoagulants have a more favourable benefit-risk ratio and are more conveniently applicable than VKAs. However, it is unclear whether these advantages include patients with CAD.…”

Section: Discussionmentioning

confidence: 99%

Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

Kägi

Kahles

Nedeltchev

et al. 2021

The Lancet Neurology

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Section: Discussionmentioning

confidence: 99%

Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

Kägi

Kahles

Nedeltchev

et al. 2021

The Lancet Neurology

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“…Our meta-analysis of 752 patients provides an updated snapshot of the current data on the safety and efficacy of VKA 14 Retrospective VKA 49 Warfarin 6 Critical Georgiadis et al 17 Retrospective VKA 202 Warfarin 3 Critical Chandra et al 15 Retrospective VKA 9 Warfarin NR Critical Engelter et al 16 Retrospective VKA 25 Warfarin 28 Critical Engelter et al 4 RCT VKA 94 Warfarin 3 Low Malferrari et al 18 Case and NOACs in CAD. Overall, 53 patients were treated with NOAC, and 699 patients received VKA.…”

Section: Discussionmentioning

confidence: 99%

Vitamin K antagonist versus novel oral anticoagulants for management of cervical artery dissection: Interactive systematic review and meta-analysis

Essibayi

Lanzino

Keser

2022

European Stroke Journal

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Purpose: Cervical artery dissection (CAD) represents a unique clinical entity with a high risk of ischemic stroke. Vitamin K antagonists (VKA) showed good efficacy in CAD management but are cumbersome to use with potentially higher bleeding rates. Novel oral anticoagulants (NOAC) are easier to use and may have similar effects but lower hemorrhagic risk. In this systematic review, we compare the efficacy of NOAC to VKA as a potential alternative treatment. Methods: The literature was searched on Pubmed, PMC, and Embase via API through the Nested Knowledge AutoLit software in February 2022 for studies evaluating both NOAC and VKA. Baseline characteristics, clinical and radiographic outcomes, and hemorrhagic and ischemic complications were collected for single and double-arm studies and analyzed using random-effect subgroup meta-analysis. Findings: Overall, 11 studies were included with 699 patients treated with VKA and 53 treated with NOAC (from three studies; two were head-to-head comparative studies). There was no statistical difference in the baseline characteristics of VKA and NOAC patients. The rates of TIA/stroke in VKA and NOAC groups were 12.3% (95% CI; 0%, 28.6%) and 5.7% (95% CI; 0%, 12.2%), respectively. Major bleeding or intracranial bleeding were comparable between groups. Lesions treated with VKA showed angiographic recanalization with a rate of 51.4% (95% CI; 35.6%, 67.1%) and for those treated with NOAC was 58.4% (95% CI; 23.9%, 93.9%). The rates of good clinical outcomes were 79.9% (95% CI; 67.6%, 92.2%) in the VKA group and 91.4% (95% CI; 78.1%, 100%) in NOAC. No statistical difference was noted among any of the outcomes between the two treatment groups. Discussion and conclusion: We highlighted comparable efficacy and safety of NOAC to VKA for stroke prevention in CAD. Further head-to-head studies are warranted to validate these results.

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“…Additionally, the different antiplatelet protocols existed between the recruited two RCTs. None used direct oral anticoagulants in the anticoagulation group, which may have a more favorable risk-benefit ratio and are more conveniently applicable than vitamin K antagonists ( 21 , 22 ). In addition, the CADISS trial has 1-year final results beyond a 3-month period and the TREAT-CAD trial evaluated the MRI outcomes (new ischemic or hemorrhagic brain lesions).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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 I2 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], I2 = 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], I2 = 0%, P = 0.181), intracranial hemorrhage (RR = 0.33 [95% CI, 0.01–7.98], I2 = 0%, P = 0.494), major extracranial bleeding (RR = 0.31 [95% CI, 0.01–7.60], I2 = 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.

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Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?

Cited by 7 publications

References 28 publications

Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

Vitamin K antagonist versus novel oral anticoagulants for management of cervical artery dissection: Interactive systematic review and meta-analysis

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

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