Quick Take: Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection: The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results

Cervical artery dissection is a common cause of ischemic stroke in young patients. Whether antiplatelet (AP) therapy or anticoagulation (AC) therapy is more effective at preventing recurrent stroke after dissection is unknown. In 2015, data from the Cervical Artery Dissection in Stroke Study (CADISS) trial showed no difference in event rates in patients treated with AC or AP at the primary endpoint of 3 months. In this study, the authors report the 1-year follow-up data from CADISS. In this randomized controlled trial, 250 patients with extracranial carotid and vertebral artery dissections with symptom onset in the prior 7 days were assigned to receive either AP or AC therapy for at least 3 months to compare the impact on the incidence of ipsilateral stroke and death. AP therapy consisted of aspirin, clopidogrel, dipyridamole, or a dual combination. For AC therapy, the recommended regimen was heparin (either unfractionated heparin or low-molecular-weight heparin) followed by warfarin, aiming for an international normalized ratio (INR) in the range of 2 to 3. At baseline, 118 patients had carotid artery dissection, and 132 had vertebral artery dissection. The most common presenting symptom was cerebral ischemia (224 patients). In the AP arm, 22.2% of patients received aspirin alone, 22.2% received clopidogrel alone, 0.8% received dipyridamole alone, 27.8% received aspirin and clopidogrel, and 15.9% received aspirin and dipyridamole. In the AC arm, 90.3% of patients received heparin and warfarin, and 9.7% received warfarin alone. Based on an intention-to-treat analysis, researchers found that at 12 months after randomization, there was no significant difference in the incidence of ipsilateral stroke, (OR 0.56, 95% CI 0.10 to 3.21). There were no deaths in the AC group and one death in the AP group, owing to a fatal recurrent stroke between 3 and 12 months in a patient who had a first recurrent stroke within the first 3 months. There was one major bleed in a patient in the AC group. Overall, results from this study show that the risk of recurrent stroke or death after cervical artery dissection is low, and that there is no difference in efficacy between anticoagulation and antiplatelet therapy in reducing this risk.

Click to read the study in JAMA Neurology

Image: PD

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