Liu Sihua, Zhang Xiao, Bai Xuesong, Yang Yutong, Wang Tao, Xu Xin, Xu Ran, Li Long, Feng Yao, Yang Kun, Wang Xue, Guo Xiaofan, Chen Jing, Ma Yan, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
China International Neuroscience Institute (China-INI), Beijing, China.
Front Neurol. 2021 Nov 24;12:745106. doi: 10.3389/fneur.2021.745106. eCollection 2021.
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. 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 statistical analysis. The analyses were performed in the intention-to-treat (ITT) and per-protocol (PP) population, respectively. 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 ( = 6.73 [95% , 1.22-37.15], = 0%, = 0.029). No difference between these two treatment groups was found for the outcomes of transient ischemic attack ( = 0.37 [95% , 0.09-1.58], = 0%, = 0.181), intracranial hemorrhage ( = 0.33 [95% , 0.01-7.98], = 0%, = 0.494), major extracranial bleeding ( = 0.31 [95% , 0.01-7.60], = 0%, = 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. 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.
颈动脉夹层（CAD）的最佳治疗方案尚不确定。本研究旨在总结当前的随机对照试验（RCT），以比较抗血小板和抗凝治疗对CAD的疗效和安全性。在主要数据库如MEDLINE、Embase和Cochrane图书馆进行了文献检索。仅纳入比较CAD患者抗血小板和抗凝治疗的RCT。分析了抗血小板与抗凝相对风险（RR）的合并估计值。使用统计分析测量异质性。分析分别在意向性治疗（ITT）人群和符合方案（PP）人群中进行。纳入了两项RCT，ITT人群中有444例患者，PP人群中有370例患者。研究质量总体较高。在ITT人群中，与抗凝组患者相比，抗血小板组患者在3个月内发生缺血性卒中的比例更高（RR = 6.73 [95%CI，1.22 - 37.15]，P = 0%，P = 0.029）。在短暂性脑缺血发作（RR = 0.37 [95%CI，0.09 - 1.58]，P = 0%，P = 0.181）、颅内出血（RR = 0.33 [95%CI，0.01 - 7.98]，P = 0%，P = 0.494）、颅外大出血（RR = 0.31 [95%CI，0.01 - 7.60]，P = 0%，P = 0.476）或3个月内这些结局的复合结局方面，这两个治疗组之间未发现差异。对于PP人群，抗血小板组和抗凝组结局的荟萃分析结果与ITT人群一致。在治疗CAD时，与抗血小板组相比，抗凝组发生缺血性卒中的风险较低，且不增加出血风险。抗凝在治疗CAD方面似乎优于抗血小板，但需要通过明确几个问题（如部位、初始症状类型和治疗方案）进行进一步验证。
