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Toward Individual Treatment in Cervical Artery Dissection: Subgroup Analysis of the TREAT-CAD Randomized Trial.
Kaufmann, Josefin E; Gensicke, Henrik; Schaedelin, Sabine; Luft, Andreas R; Goeggel-Simonetti, Barbara; Fischer, Urs; Michel, Patrik; Strambo, Davide; Kägi, Georg; Vehoff, Jochen; Nedeltchev, Krassen; Kahles, Timo; Kellert, Lars; Rosenbaum, Sverre; von Rennenberg, Regina; Riegler, Christoph; Seiffge, David; Sarikaya, Hakan; Zietz, Annaelle; Wischmann, Johannes; Polymeris, Alexandros A; Hänsel, Martin; Globas, Christoph; Bonati, Leo H; Brehm, Alex; De Marchis, Gian Marco; Peters, Nils; Nolte, Christian H; Christensen, Hanne; Wegener, Susanne; Psychogios, Marios-Nikos; Arnold, Marcel; Lyrer, Philippe; Traenka, Christopher; Engelter, Stefan T.
Afiliação
  • Kaufmann JE; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Gensicke H; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
  • Schaedelin S; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Luft AR; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
  • Goeggel-Simonetti B; Department of Clinical Research, Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Fischer U; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland.
  • Michel P; Center for Neurology and Rehabilitation, Cereneo, Vitznau, Switzerland.
  • Strambo D; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • Kägi G; Department of Neuropediatrics, Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland.
  • Vehoff J; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Nedeltchev K; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • Kahles T; Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
  • Kellert L; Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
  • Rosenbaum S; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • von Rennenberg R; Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland.
  • Riegler C; Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland.
  • Seiffge D; Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland.
  • Sarikaya H; Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland.
  • Zietz A; Medical Faculty, University of Basel, Basel, Switzerland.
  • Wischmann J; Department of Neurology, Ludwig Maximilian University, Munich, Germany.
  • Polymeris AA; Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University, Munich, Germany.
  • Hänsel M; Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark.
  • Globas C; Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Bonati LH; Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Brehm A; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • De Marchis GM; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
  • Peters N; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Nolte CH; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
  • Christensen H; Department of Neurology, Ludwig Maximilian University, Munich, Germany.
  • Wegener S; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Psychogios MN; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland.
  • Arnold M; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland.
  • Lyrer P; Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Traenka C; Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
  • Engelter ST; Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Ann Neurol ; 95(5): 886-897, 2024 May.
Article em En | MEDLINE | ID: mdl-38362818
ABSTRACT

OBJECTIVE:

Uncertainty remains regarding antithrombotic treatment in cervical artery dissection. This analysis aimed to explore whether certain patient profiles influence the effects of different types of antithrombotic treatment.

METHODS:

This was a post hoc exploratory analysis based on the per-protocol dataset from TREAT-CAD (NCT02046460), a randomized controlled trial comparing aspirin to anticoagulation in patients with cervical artery dissection. We explored the potential effects of distinct patient profiles on outcomes in participants treated with either aspirin or anticoagulation. Profiles included (1) presenting with ischemia (no/yes), (2) occlusion of the dissected artery (no/yes), (3) early versus delayed treatment start (median), and (4) intracranial extension of the dissection (no/yes). Outcomes included clinical (stroke, major hemorrhage, death) and magnetic resonance imaging outcomes (new ischemic or hemorrhagic brain lesions) and were assessed for each subgroup in separate logistic models without adjustment for multiple testing.

RESULTS:

All 173 (100%) per-protocol participants were eligible for the analyses. Participants without occlusion had decreased odds of events when treated with anticoagulation (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.07-0.86). This effect was more pronounced in participants presenting with cerebral ischemia (n = 118; OR = 0.16, 95% CI = 0.04-0.55). In the latter, those with early treatment (OR = 0.26, 95% CI = 0.07-0.85) or without intracranial extension of the dissection (OR = 0.34, 95% CI = 0.11-0.97) had decreased odds of events when treated with anticoagulation.

INTERPRETATION:

Anticoagulation might be preferable in patients with cervical artery dissection presenting with ischemia and no occlusion or no intracranial extension of the dissection. These findings need confirmation. ANN NEUROL 2024;95886-897.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aspirina / Dissecação da Artéria Vertebral / Anticoagulantes Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aspirina / Dissecação da Artéria Vertebral / Anticoagulantes Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article