CADISP Therapeutic Aspects

Antiplatelets versus anticoagulation in cervical artery dissection

The widespread preference of anticoagulants over antiplatelets in patients with cervical artery dissection (CAD) is empiric rather than evidence-based. Recently, the CADISP group rendered a comprehensive overview about pathophysiological observations and clinical experiences with anticoagulants versus antiplatelets including a systematic meta-analysis of the existing clinical data on antithrombotic therapy in extracranial internal carotid dissection.[1] As a result, there are several putative arguments in favor as well as against immediate anticoagulation in CAD patients. Thus, a randomized controlled trial (RCT) comparing antiplatelets with anticoagulation is needed and ethically justified. However, due to the large sample size which is required to gather meaningful results - we estimate a sample size of at least 1400 patients in each treatment arm -, such a trial represents a huge venture. Therefore, a RCT is likely to face difficulties in obtaining funding, recruiting centers and patients. Nevertheless, in CAD a large RCT is important and could solve the decades-long debate whether to use immediate anticoagulation or not. Therefore, it is our goal to perform such a trial in the future.

In the meantime, the multi-center CADISP registry provides the opportunity to ascertain comprehensive data on consecutive CAD patients. This approach results in a large CAD databank with systematic outcome assessment stratified to the applied antithrombotic agents. Comparative analyses of these data may be helpful for the design and the promotion of a RCT, either alone or by analyzing the data together with preexisting data of smaller series in a systematic review.[2] Such data may even serve as means to approximate best medical treatment in CAD, in case a RCT prove not to be feasible.
1. Engelter ST, Brandt T, Debette S, Caso V, Lichy C,Pezzini A, Abboud S, Bersano A, Dittrich R, Grond-Ginsbach C, Hausser I,Kloss M, Grau A, Tatlisumak T, Leys D, Lyrer PA for the Cervical Artery Dissection in Ischemic Stroke Patients (CADISP)-Study Group.
Antiplatelets vs anticoagulation in cervical artery dissection ľa review
Stroke 2007; 38 2605-2611 
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2. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection (Cochrane Review). In: The Cochrane Library, Issue 7, 2010.
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