Portal de investigação
Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP- CAD Study
Autores da FMUP
Participantes de fora da FMUP
- Yaghi, Shadi
- Shu, Liqi
- Mandel, Daniel
- Guerrero, Christopher R. Leon
- Henninger, Nils
- Muppa, Jayachandra
- Affan, Muhammad
- Lodhi, Omair Ul Haq
- Heldner, Mirjam R.
- Antonenko, Kateryna
- Seiffge, David
- Arnold, Marcel
- Omran, Setareh Salehi
- Crandall, Ross
- Lester, Evan
- Mena, Diego Lopez
- Arauz, Antonio
- Nehme, Ahmad
- Boulanger, Marion
- Touze, Emmanuel
- Sousa, Joao Andre
- Sargento-Freitas, Joao
- Barata, Vasco
- Brito, Maria Teresa
- Khan, Muhib
- Mallick, Dania
- Rothstein, Aaron
- Khazaal, Ossama
- Kaufmann, Josefin E.
- Engelter, Stefan T.
- Traenka, Christopher
- de Sousa, Diana Aguiar
- Soares, Mafalda
- Rosa, Sara
- Zhou, Lily W.
- Gandhi, Preet
- Field, Thalia S.
- Mancini, Steven
- Metanis, Issa
- Leker, Ronen R.
- Pan, Kelly
- Dantu, Vishnu
- Baumgartner, Karl
- Burton, Tina
- Von Rennenberg, Regina
- Nolte, Christian H.
- Choi, Richard
- MacDonald, Jason
- Shahripour, Reza Bavarsad
- Guo, Xiaofan
- Ghannam, Malik
- Almajali, Mohammad
- Samaniego, Edgar A.
- Sanchez, Sebastian
- Rioux, Bastien
- Zine-Eddine, Faycal
- Poppe, Alexandre
- Fonseca, Ana Catarina
- Baptista, Maria Fortuna
- Cruz, Diana
- Romoli, Michele
- De Marco, Giovanna
- Longoni, Marco
- Keser, Zafer
- Griffin, Kim
- Kuohn, Lindsey
- Frontera, Jennifer
- Amar, Jordan
- Giles, James
- Zedde, Marialuisa
- Pascarella, Rosario
- Grisendi, Ilaria
- Nzwalo, Hipolito
- Liebeskind, David S.
- Molaie, Amir
- Cavalier, Annie
- Kam, Wayneho
- Mac Grory, Brian
- Al Kasab, Sami
- Anadani, Mohammad
- Kicielinski, Kimberly
- Eltatawy, Ali
- Chervak, Lina
- Chulluncuy-Rivas, Roberto
- Aziz, Yasmin
- Bakradze, Ekaterina
- Thanh Lam Tran
- Rodrigo-Gisbert, Marc
- Requena, Manuel
- Velez, Faddi Saleh
- Gracia, Jorge Ortiz
- Mudassani, Varsha
- de Havenon, Adam
- Vishnu, Venugopalan Y.
- Yaddanapudi, Sridhara
- Adams, Latasha
- Browngoehl, Abigail
- Ranasinghe, Tamra
- Dunston, Randy
- Lynch, Zachary
- Penckofer, Mary
- Siegler, James
- Mayer, Silvia
- Willey, Joshua
- Zubair, Adeel
- Cheng, Yee Kuang
- Sharma, Richa
- Marto, Joao Pedro
- Ferreira, Vitor Mendes
- Klein, Piers
- Nguyen, Thanh N.
- Asad, Syed Daniyal
- Sarwat, Zoha
- Balabhadra, Anvesh
- Patel, Shivam
- Secchi, Thais
- Martins, Sheila
- Mantovani, Gabriel
- Kim, Young Dae
- Krishnaiah, Balaji
- Elangovan, Cheran
- Lingam, Sivani
- Quereshi, Abid
- Fridman, Sebastian
- Alvarado, Alonso
- Khasiyev, Farid
- Linares, Guillermo
- Mannino, Marina
- Terruso, Valeria
- Vassilopoulou, Sofia
- Tentolouris, Vasilis
- Martinez-Marino, Manuel
- Wall, Victor Carrasco
- Indraswari, Fransisca
- El Jamal, Sleiman
- Liu, Shilin
- Alvi, Muhammad
- Ali, Farman
- Sarvath, Mohammed
- Morsi, Rami Z.
- Kass-Hout, Tareq
- Shi, Feina
- Zhang, Jinhua
- Sokhi, Dilraj
- Said, Jamil
- Simpkins, Alexis N.
- Gomez, Roberto
- Sen, Shayak
- Ghani, Mohammad
- Elnazeir, Marwa
- Xiao, Han
- Kala, Narendra
- Khan, Farhan
- Stretz, Christoph
- Mohammadzadeh, Nahid
- Goldstein, Eric
- Furie, Karen
Unidades de investigação
Abstract
BACKGROUND: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-treated crossover approach and only included outcomes occurring with the above treatments. RESULTS: The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45-1.12]; P=0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28-2.24]; P=0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35-5.45]; P=0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53-20.13]; P=0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18-0.88]; P (interaction)=0.009). CONCLUSIONS: Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.
Dados da publicação
- ISSN/ISSNe:
- 1524-4628, 0039-2499
- Tipo:
- Article
- Páginas:
- 908-918
- Link para outro recurso:
- www.scopus.com
Stroke Lippincott Williams and Wilkins Ltd.
Citações Recebidas na Web of Science: 12
Citações Recebidas na Scopus: 16
Documentos
- Não há documentos
Filiações
Keywords
- anticoagulants; arteries; hemorrhage; ischemic stroke; stroke
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Citar a publicação
Yaghi S,Shu L,Mandel D,Guerrero CRL,Henninger N,Muppa J,Affan M,Lodhi OUH,Heldner MR,Antonenko K,Seiffge D,Arnold M,Omran SS,Crandall R,Lester E,Mena DL,Arauz A,Nehme A,Boulanger M,Touze E,Sousa JA,Sargento J,Barata V,Castro P,Brito MT,Khan M,Mallick D,Rothstein A,Khazaal O,Kaufmann JE,Engelter ST,Traenka C,de Sousa DA,Soares M,Rosa S,Zhou LW,Gandhi P,Field TS,Mancini S,Metanis I,Leker RR,Pan K,Dantu V,Baumgartner K,Burton T,Von R,Nolte CH,Choi R,MacDonald J,Shahripour RB,Guo X,Ghannam M,Almajali M,Samaniego EA,Sanchez S,Rioux B,Zine F,Poppe A,Fonseca AC,Baptista MF,Cruz D,Romoli M,De Marco G,Longoni M,Keser Z,Griffin K,Kuohn L,Frontera J,Amar J,Giles J,Zedde M,Pascarella R,Grisendi I,Nzwalo H,Liebeskind DS,Molaie A,Cavalier A,Kam W,Mac B,Al Kasab S,Anadani M,Kicielinski K,Eltatawy A,Chervak L,Chulluncuy R,Aziz Y,Bakradze E,Thanh T,Rodrigo M,Requena M,Velez FS,Gracia JO,Mudassani V,de Havenon A,Vishnu VY,Yaddanapudi S,Adams L,Browngoehl A,Ranasinghe T,Dunston R,Lynch Z,Penckofer M,Siegler J,Mayer S,Willey J,Zubair A,Cheng YK,Sharma R,Marto JP,Ferreira VM,Klein P,Nguyen TN,Asad SD,Sarwat Z,Balabhadra A,Patel S,Secchi T,Martins S,Mantovani G,Kim YD,Krishnaiah B,Elangovan C,Lingam S,Quereshi A,Fridman S,Alvarado A,Khasiyev F,Linares G,Mannino M,Terruso V,Vassilopoulou S,Tentolouris V,Martinez M,Wall VC,Indraswari F,El Jamal S,Liu S,Alvi M,Ali F,Sarvath M,Morsi RZ,Kass T,Shi F,Zhang J,Sokhi D,Said J,Simpkins AN,Gomez R,Sen S,Ghani M,Elnazeir M,Xiao H,Kala N,Khan F,Stretz C,Mohammadzadeh N,Goldstein E,Furie K. Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP- CAD Study. Stroke. 2024. 55. (4):p. 908-918. IF:8,300. (1).
