Lee Seong-Joon, Kim Min, Park So Young, Park Ji Hyun, Park Bumhee, Jung Woo Sang, Choi Jin Wook, Lim Yong Cheol, Hong Ji Man, Lee Jin Soo
Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea.
Front Neurol. 2024 Dec 4;15:1469697. doi: 10.3389/fneur.2024.1469697. eCollection 2024.
This study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD).
This study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated with anti-thrombotics. Patients were dichotomized to AC and AP based on a treatment policy analysis. Primary endpoints were a composite of ischemic early neurological deterioration, recurrent ischemic or hemorrhagic stroke, or 3-month mortality. Arterial changes were evaluated both in the early (during admission) and late (after discharge) periods. A treatment effectiveness analysis was also performed with AC, AP and a third group of antithrombotic cross-overs. Propensity score matching (PSM) was used to adjust significant baseline differences.
In unruptured IAD patients ( = 311), the AC group ( = 211) presented with a higher rate of ischemic stroke or TIA (74.4% vs. 51.0%, < 0.001) and steno-occlusive morphology (vs. dilatation, 63.0% vs. 39.0%, < 0.001) compared to AP group ( = 100). After PSM, there was no difference in rates of primary endpoint (9.4% vs. 6.5%, = 0.470). The results of the treatment effectiveness analysis resembled that of the treatment policy analysis. However, there was a high rate of cross-overs from AC to AP (57/211 [27.0%]). In this group, there was a higher rate of early arterial changes (26.8% vs. 13.1%, = 0.019) compared to the AC group.
In patients with unruptured IAD, this study did not show differences in primary endpoints according to antithrombotic regimen, while there was a high rate of cross-overs from AC to AP.
本研究旨在评估颅内动脉夹层（IAD）抗血小板（AP）治疗与抗凝（AC）治疗在结局差异方面的真实世界数据。
本研究纳入了2010年至2021年间接受抗栓治疗的有症状未破裂IAD患者。根据治疗策略分析将患者分为AC组和AP组。主要终点为缺血性早期神经功能恶化、复发性缺血性或出血性卒中或3个月死亡率的复合终点。在早期（住院期间）和晚期（出院后）评估动脉变化。还对AC组、AP组和第三组抗栓交叉治疗组进行了治疗效果分析。采用倾向评分匹配（PSM）来调整显著的基线差异。
在未破裂IAD患者（n = 311）中，与AP组（n = 100）相比，AC组（n = 211）的缺血性卒中或短暂性脑缺血发作（TIA）发生率更高（74.4%对51.0%，P < 0.001），狭窄闭塞形态发生率更高（对扩张，63.0%对39.0%，P < 0.001）。PSM后，主要终点发生率无差异（9.4%对6.5%，P = 0.470）。治疗效果分析结果与治疗策略分析结果相似。然而，从AC转换至AP的比例较高（57/211 [27.0%]）。在该组中，与AC组相比，早期动脉变化发生率更高（26.8%对13.1%，P = 0.019）。
在未破裂IAD患者中，本研究未显示抗栓方案在主要终点方面存在差异，但从AC转换至AP的比例较高。
