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

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 th...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Sihua Liu, Xiao Zhang, Xuesong Bai, Yutong Yang, Tao Wang, Xin Xu, Ran Xu, Long Li, Yao Feng, Kun Yang, Xue Wang, Xiaofan Guo, Jing Chen, Yan Ma, Liqun Jiao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	cervical artery dissection antiplatelet anticoagulation ischemic stroke meta-analysis Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/4f64e4aec3444d49b16bc94d3a5ce633
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4f64e4aec3444d49b16bc94d3a5ce633
record_format	dspace
spelling	oai:doaj.org-article:4f64e4aec3444d49b16bc94d3a5ce6332021-11-30T17:47:31ZAntiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials1664-229510.3389/fneur.2021.745106https://doaj.org/article/4f64e4aec3444d49b16bc94d3a5ce6332021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.745106/fullhttps://doaj.org/toc/1664-2295Objective: 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.Sihua LiuSihua LiuSihua LiuXiao ZhangXiao ZhangXuesong BaiXuesong BaiYutong YangTao WangTao WangXin XuXin XuRan XuRan XuLong LiLong LiYao FengYao FengKun YangXue WangXiaofan GuoJing ChenYan MaYan MaLiqun JiaoLiqun JiaoLiqun JiaoFrontiers Media S.A.articlecervical artery dissectionantiplateletanticoagulationischemic strokemeta-analysisNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cervical artery dissection antiplatelet anticoagulation ischemic stroke meta-analysis Neurology. Diseases of the nervous system RC346-429
spellingShingle	cervical artery dissection antiplatelet anticoagulation ischemic stroke meta-analysis Neurology. Diseases of the nervous system RC346-429 Sihua Liu Sihua Liu Sihua Liu Xiao Zhang Xiao Zhang Xuesong Bai Xuesong Bai Yutong Yang Tao Wang Tao Wang Xin Xu Xin Xu Ran Xu Ran Xu Long Li Long Li Yao Feng Yao Feng Kun Yang Xue Wang Xiaofan Guo Jing Chen Yan Ma Yan Ma Liqun Jiao Liqun Jiao Liqun Jiao Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
description	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.
format	article
author	Sihua Liu Sihua Liu Sihua Liu Xiao Zhang Xiao Zhang Xuesong Bai Xuesong Bai Yutong Yang Tao Wang Tao Wang Xin Xu Xin Xu Ran Xu Ran Xu Long Li Long Li Yao Feng Yao Feng Kun Yang Xue Wang Xiaofan Guo Jing Chen Yan Ma Yan Ma Liqun Jiao Liqun Jiao Liqun Jiao
author_facet	Sihua Liu Sihua Liu Sihua Liu Xiao Zhang Xiao Zhang Xuesong Bai Xuesong Bai Yutong Yang Tao Wang Tao Wang Xin Xu Xin Xu Ran Xu Ran Xu Long Li Long Li Yao Feng Yao Feng Kun Yang Xue Wang Xiaofan Guo Jing Chen Yan Ma Yan Ma Liqun Jiao Liqun Jiao Liqun Jiao
author_sort	Sihua Liu
title	Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_short	Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full	Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_fullStr	Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed	Antiplatelet vs. Anticoagulation in Cervical Artery Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_sort	antiplatelet vs. anticoagulation in cervical artery dissection: a systematic review and meta-analysis of randomized controlled trials
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/4f64e4aec3444d49b16bc94d3a5ce633
work_keys_str_mv	AT sihualiu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT sihualiu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT sihualiu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xiaozhang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xiaozhang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xuesongbai antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xuesongbai antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yutongyang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT taowang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT taowang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xinxu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xinxu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT ranxu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT ranxu antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT longli antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT longli antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yaofeng antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yaofeng antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT kunyang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xuewang antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT xiaofanguo antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT jingchen antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yanma antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yanma antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT liqunjiao antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT liqunjiao antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT liqunjiao antiplateletvsanticoagulationincervicalarterydissectionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
_version_	1718406377681977344

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

Ejemplares similares