Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis.

OBJECTIVE: To present the results of the nonrandomized arm of the Cervical Artery Dissection in Stroke Study (CADISS-NR) trial, comparing anticoagulation and antiplatelets for prevention of recurrent stroke after carotid and vertebral dissection, and perform a meta-analysis of these results with previously published studies comparing the 2 therapeutic strategies.

METHODS: A total of 88 patients from 22 centers with extracranial carotid and vertebral dissection were recruited within 1 month of symptom onset. The primary endpoint was recurrent stroke at 3 months. A systematic review was performed, and results of published studies included in a meta-analysis with the CADISS-NR results.

RESULTS: In CADISS-NR, one patient in each group had recurrent ischemic stroke (antiplatelet 1/59 [1.69% ], anticoagulation 1/28 [3.57%]). At the primary endpoint of 3 months, 3 (5.08%) antiplatelet patients had recurrent TIA, compared with none in the anticoagulation group. For meta-analysis, there were data from 40 nonrandomized studies including 1,636 patients. There was no significant difference between the 2 treatments in recurrent stroke risk (antiplatelet 13/499 [2.6%], anticoagulant 20/1,137 [1.8%], odds ratio [OR] 1.49) or risk of death (antiplatelet 5/499 [1.00%], anticoagulant 9/1,137 [0.80%], OR 1.27).

CONCLUSION: There is no evidence for superiority of anticoagulation or antiplatelet therapy in prevention of stoke after carotid and vertebral artery dissection; however, all data are from nonrandomized studies and randomized studies are required. The nonrandomized CADISS data show a lower rate of recurrent stroke than reported in some previous studies.

CLINICAL TRIAL REGISTRATION INFORMATION: www.dissection.co.uk, ISRNCTN44555237.