Kim Yang-Ki, Schulman Sam
Department of Medicine, McMaster University, Hamilton ON, Canada.
Thromb Res. 2009 Apr;123(6):810-21. doi: 10.1016/j.thromres.2009.01.013. Epub 2009 Mar 9.
Cervical artery dissection is often treated with anticoagulants to prevent ischemic stroke. The risk-benefit ratio of anticoagulation versus antiplatelet therapy is unclear.
To provide an educational review of current data on the disease to explain the rationale for the treatment options and to explore the results of management studies in order to determine if anticoagulation is justified.
We searched the databases MEDLINE and EMBASE as well as bibliographies for information on anticoagulants and antiplatelet agents in cervical, i.e. carotid and/or vertebral artery, dissection.
There are no randomized controlled trials on the treatment. One systematic review from 2003 identified 20 case series or cohort studies. We identified 9 additional studies with a total of 1,033 patients. Of those, 731 received anticoagulation sometimes followed by platelet inhibition vs. 282 patients treated with antiplatelet agents alone. The rate of ischemic stroke was 2.3% vs. 6.9% and bleeding complications were reported in 0.7% vs. 0%.
It cannot be excluded that there is a net benefit from anticoagulant therapy in cervical dissection, but the studies are flawed by considerable bias. Very ill patients at a high risk of ischemic stroke may have been given aspirin due to fear of hemorrhagic complications. A randomized controlled trial is planned and will be crucial to resolve this issue.
颈动脉夹层通常采用抗凝剂治疗以预防缺血性卒中。抗凝治疗与抗血小板治疗的风险效益比尚不清楚。
对该疾病的现有数据进行教育性综述，以解释治疗选择的基本原理，并探讨管理研究的结果，从而确定抗凝治疗是否合理。
我们检索了MEDLINE和EMBASE数据库以及参考文献，以获取有关颈（即颈动脉和/或椎动脉）动脉夹层中抗凝剂和抗血小板药物的信息。
尚无关于该治疗的随机对照试验。2003年的一项系统评价纳入了20个病例系列或队列研究。我们又识别出9项研究，共涉及1033例患者。其中，731例接受了抗凝治疗，有时随后进行血小板抑制，而282例患者仅接受抗血小板药物治疗。缺血性卒中发生率分别为2.3%和6.9%，出血并发症报告率分别为0.7%和0%。
不能排除抗凝治疗对颈动脉夹层有净获益，但这些研究存在相当大的偏倚。由于担心出血并发症，可能对缺血性卒中高危的重病患者使用了阿司匹林。计划开展一项随机对照试验，这对于解决该问题至关重要。
