PMID- 35922714
OWN - NLM
STAT- MEDLINE
DCOM- 20220907
LR  - 20220907
IS  - 1179-6901 (Electronic)
IS  - 1174-5886 (Print)
IS  - 1174-5886 (Linking)
VI  - 22
IP  - 3
DP  - 2022 Sep
TI  - Antiplatelets Versus Anticoagulation in Cervical Artery Dissection: A Systematic 
      Review and Meta-analysis of 2064 Patients.
PG  - 187-203
LID - 10.1007/s40268-022-00398-z [doi]
AB  - BACKGROUND AND OBJECTIVES: In young people aged < 50 years, cervical artery 
      dissection (CeAD) is among the most common causes of stroke. Currently, there is 
      no consensus regarding the safest and most effective antithrombotic treatment for 
      CeAD. We aimed to synthesize concrete evidence from studies that compared the 
      efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for 
      CeAD. METHODS: We searched major electronic databases/search engines from 
      inception till September 2021. Cohort studies and randomized controlled trials 
      (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A 
      meta-analysis was conducted using articles that were obtained and found to be 
      relevant. Mean difference (MD) with 95% confidence interval (CI) was used for 
      continuous data and odds ratio (OR) with 95% CI for dichotomous data. RESULTS: 
      Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom 
      received antiplatelets and 1155 (56%) received anticoagulants. Our analysis 
      showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 
      95% CI 0.03-7.58), > 3-month mortality (OR 1.63, 95% CI 0.40-6.56), recurrent 
      stroke (OR 0.97, 95% CI 0.46-2.02), recurrent transient ischaemic attack (TIA) 
      (OR 0.93, 95% CI 0.44-1.98), symptomatic intracranial haemorrhage (sICH) (OR 
      0.38, 95% CI 0.12-1.19), and complete recanalization (OR 0.70, 95% CI 0.46-1.06). 
      Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs 
      (OR 6.97, 95% CI 1.25-38.83). CONCLUSION: Our study did not show a considerable 
      difference between the two groups, as all outcomes showed non-significant 
      differences between them, except for primary ischaemic stroke (RCTs) and complete 
      recanalization (observational studies), which showed a significant favour of AC 
      over AP. Even though primary ischaemic stroke is an important outcome, several 
      crucial points that could affect these results should be paid attention to. These 
      include the incomplete adjustment for the confounding effect of AP-AC doses, 
      frequencies, administration compliance, and others. We recommend more 
      well-designed studies to assess if unnecessary anticoagulation can be avoided in 
      CeAD.
CI  - (c) 2022. The Author(s).
FAU - Hagrass, Abdulrahman Ibrahim
AU  - Hagrass AI
AD  - Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
FAU - Almaghary, Bashar Khaled
AU  - Almaghary BK
AD  - Faculty of Pharmacy, Al-Azhar University-Gaza, Gaza Strip, Palestine.
FAU - Mostafa, Mohamed Abdelhady
AU  - Mostafa MA
AD  - Paradise Neurology and Rehabilitation Clinics, Alexandria, Egypt.
FAU - Elfil, Mohamed
AU  - Elfil M
AD  - Department of Neurological Sciences, University of Nebraska Medical Center, 
      Omaha, NE, USA.
FAU - Elsayed, Sarah Makram
AU  - Elsayed SM
AD  - Faculty of Medicine, October 6 University, Giza, Egypt.
FAU - Aboali, Amira A
AU  - Aboali AA
AD  - Faculty of Medicine, Alexandria University, El-Shatby, 22 El-Guish Road, 
      Alexandria, 21526, Egypt.
FAU - Hamdallah, Aboalmagd
AU  - Hamdallah A
AD  - Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
FAU - Hasan, Mohammed Tarek
AU  - Hasan MT
AD  - Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
FAU - Al-Kafarna, Mohammed
AU  - Al-Kafarna M
AD  - Faculty of Pharmacy, Al-Azhar University-Gaza, Gaza Strip, Palestine.
FAU - Ragab, Khaled Mohamed
AU  - Ragab KM
AD  - Faculty of Medicine, Minia University, Minia, Egypt.
FAU - Doheim, Mohamed Fahmy
AU  - Doheim MF
AUID- ORCID: 0000-0001-8279-5078
AD  - Faculty of Medicine, Alexandria University, El-Shatby, 22 El-Guish Road, 
      Alexandria, 21526, Egypt. fahmydoheim@alumni.harvard.edu.
LA  - eng
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20220803
PL  - New Zealand
TA  - Drugs R D
JT  - Drugs in R&D
JID - 100883647
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Anticoagulants/adverse effects
MH  - Arteries
MH  - Humans
MH  - *Ischemic Stroke
MH  - Observational Studies as Topic
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - *Stroke/drug therapy/etiology/prevention & control
PMC - PMC9433613
COIS- Abdulrahman Ibrahim Hagrass, Bashar Khaled Almaghary, Mohamed Abdelhady Mostafa, 
      Mohamed Elfil, Sarah Makram Elsayed, Amira A. Aboali, Aboalmagd Hamdallah, 
      Mohammed Tarek Hasan, Mohammed Al-kafarna, Khaled Mohamed Ragab and Mohamed Fahmy 
      Doheim declare that they have no potential conflicts of interest that might be 
      relevant to the content of this article.
EDAT- 2022/08/04 06:00
MHDA- 2022/09/08 06:00
PMCR- 2022/08/03
CRDT- 2022/08/03 23:33
PHST- 2022/07/19 00:00 [accepted]
PHST- 2022/08/04 06:00 [pubmed]
PHST- 2022/09/08 06:00 [medline]
PHST- 2022/08/03 23:33 [entrez]
PHST- 2022/08/03 00:00 [pmc-release]
AID - 10.1007/s40268-022-00398-z [pii]
AID - 398 [pii]
AID - 10.1007/s40268-022-00398-z [doi]
PST - ppublish
SO  - Drugs R D. 2022 Sep;22(3):187-203. doi: 10.1007/s40268-022-00398-z. Epub 2022 Aug 
      3.