Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
J Neural Transm (Vienna). 2013 Feb;120(2):335-8. doi: 10.1007/s00702-012-0942-4. Epub 2012 Dec 11.
Spontaneous dissection of the internal carotid artery is a leading cause of stroke and TIA, particularly in young patients. The antithrombotic treatment with or without an interventional procedure is a unanimously accepted indication for the prevention of the ischemic events in these patients. Whether anticoagulants or antiplatelets as antithrombotics are a better option is a matter of debate. The authors, based on clinical and pathophysiological data in the published studies and their own experience argue in favour of antiplatelets in most cases, without excluding the need of anticoagulants in some cases, due to the lack of objective proofs for the superiority of anticoagulants in this pathology and at the same time, a better safety profile of antiplatelets. To have a clear-cut answer to this debate, a large comparative randomized clinical trial between the two types of treatment is desirable.
颈内动脉自发性夹层是中风和 TIA 的主要原因，尤其是在年轻患者中。抗血栓治疗（联合或不联合介入治疗）是预防这些患者发生缺血事件的一致适应证。抗凝剂或抗血小板药物作为抗血栓药物，哪种更优仍存在争议。作者根据已发表研究中的临床和病理生理学数据以及自身经验，在大多数情况下支持使用抗血小板药物，同时也不排除在某些情况下需要使用抗凝剂，因为缺乏抗凝剂在该病理状态下具有优越性的客观证据，同时抗血小板药物的安全性更好。为了对这一争议有明确的答案，需要进行两种治疗方法的大型随机对照临床试验。
