Abstract Number ‐ 256: Anti‐Thrombotic Therapy for Stroke Prevention in Cervical Artery Dissection: protocol of a multicenter international study

Abstract

Introduction Cervical artery dissection (CAD) is a common cause of stroke in the young and carries a high risk of early recurrence. Traditionally, the treatment consisted of antithrombotic therapy for at least 3months. There is mixed evidence on whether antiplatelet therapy is as effective as anticoagulation in such patients, and prior studies are limited by small sample size due to the low incidence of CAD, as well as not investigating more modern treatment regimens such as direct oral anticoagulants (DOAC) and increasingly utilized dual antiplatelet therapy (DAPT) strategies. The Anti‐Thrombotic Therapy for Stroke Prevention in Cervical Artery Dissection (STOP‐CAD)studyaims to compare the safety and effectiveness of different antithrombotic regimens in patients with acute spontaneous CAD. We hypothesize thatdual antiplatelet therapy (DAPT) followed by a single agent has comparable safety and efficacy to anticoagulation in patients with CAD. Methods STOP‐CAD is amulticenter cross‐sectional international retrospective study.All patientsaged 18–89 years with imaging‐confirmed diagnosis of non‐traumatic CAD treated with antithrombotic therapy will be included. Imaging diagnosis will be adjudicated by the principal investigator from each individual site. Patients present with CAD in the setting of major trauma will be excluded. Baseline demographics, clinical, laboratory and imaging information will becollected. Outcomes include subsequent ischemic stroke, symptomatic intracranial hemorrhage, major hemorrhage, recanalization status, and death within 180 days. We will compare the clinical outcomes between antiplatelet and anticoagulation groups using Cox regression models, and the radiographic outcomes across the two groups using logistic regression models. We will use inverse probability of treatment weighting and adjust for prespecified variable as well as variables that differ between the two groups. We will use propensity score matching with and without replacement for the outcome analyses. Results Currently at least 40 international sites have agreed to contribute to this study. Multiple sites have already started the data input process, and more have started the IRB process. We expect the data collection to be completed by the end of December 2022, and the data analysis to be completed by the end of June 2023. Conclusions STOP‐CAD will provide real world data comparing the safety and efficacy of DAPT vs. anticoagulation in patients with cervical artery dissection. In addition, multiple sub‐studies will be conducted using the same database on topics such as efficacy of interventional treatment and predictors of poor outcomes.