Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia.
J Neurol Neurosurg Psychiatry. 2022 Jul;93(7):686-692. doi: 10.1136/jnnp-2021-328338. Epub 2022 May 4.
To explore the impact of antithrombotic therapy discontinuation in the postacute phase of cervical artery dissection (CeAD) on the mid-term outcome of these patients.
In a cohort of consecutive patients with first-ever CeAD, enrolled in the setting of the multicentre Italian Project on Stroke in Young Adults Cervical Artery Dissection, we compared postacute (beyond 6 months since the index CeAD) outcomes between patients who discontinued antithrombotic therapy and patients who continued taking antithrombotic agents during follow-up. Primary outcome was a composite of ischaemic stroke and transient ischaemic attack. Secondary outcomes were (1) Brain ischaemia ipsilateral to the dissected vessel and (2) Recurrent CeAD. Associations with the outcome of interest were assessed by the propensity score (PS) method.
Of the 1390 patients whose data were available for the outcome analysis (median follow-up time in patients who did not experience outcome events, 36.0 months (25th-75th percentile, 62.0)), 201 (14.4%) discontinued antithrombotic treatment. Primary outcome occurred in 48 patients in the postacute phase of CeAD. In PS-matched samples (201 vs 201), the incidence of primary outcomes among patients taking antithrombotics was comparable with that among patients who discontinued antithrombotics during follow-up (5.0% vs 4.5%; p(log rank test)=0.526), and so was the incidence of the secondary outcomes ipsilateral brain ischaemia (4.5% vs 2.5%; p(log rank test)=0.132) and recurrent CeAD (1.0% vs 1.5%; p(log rank test)=0.798).
Discontinuation of antithrombotic therapy in the postacute phase of CeAD does not appear to increase the risk of brain ischaemia during follow-up.
探讨颈内动脉夹层（CeAD）急性后期停止抗栓治疗对这些患者中期预后的影响。
在多中心意大利青年卒中项目颈内动脉夹层队列中连续纳入首次发生 CeAD 的患者，我们比较了抗栓治疗停止和随访期间继续使用抗栓药物的患者在急性后期（距 CeAD 指数事件超过 6 个月）的预后。主要结局是缺血性卒中和短暂性脑缺血发作的复合事件。次要结局是（1）与夹层血管同侧的脑缺血；（2）复发性 CeAD。通过倾向评分（PS）方法评估与感兴趣结局的相关性。
1390 例患者的数据可用于结局分析（未发生结局事件患者的中位随访时间，36.0 个月（25 至 75 百分位数，62.0）），其中 201 例（14.4%）停止抗栓治疗。CeAD 急性后期有 48 例发生主要结局。在 PS 匹配的样本中（201 例 vs 201 例），接受抗栓治疗的患者发生主要结局的比例与随访期间停止抗栓治疗的患者相似（5.0% vs 4.5%；log rank 检验 p=0.526），同侧脑缺血的发生率（4.5% vs 2.5%；log rank 检验 p=0.132）和复发性 CeAD（1.0% vs 1.5%；log rank 检验 p=0.798）也是如此。
CeAD 急性后期停止抗栓治疗似乎不会增加随访期间脑缺血的风险。
