Abstract
BackgroundCervical artery dissection (CeAD) patients with or without stroke are frequently treated with either antiplatelet agents or vitamin K antagonists (VKAs), but few data are reported on the use of nonvitamin K oral anticoagulants (NOACs).MethodsBetween November 2011 and January 2014, we recorded data from patients with a stroke due to vertebral (VAD) or internal carotid artery dissection (ICAD). Patients using oral anticoagulants were included in the study and were divided into two treatment groups: patients using NOACs and those using VKAs. Excellent outcome was defined on modified Rankin Scale (mRS) ≤1 at 6 months.ResultsOf 68 stroke patients (67% male; median age 45 [39–53]), six (8.8%; two with VAD and four with ICAD) were treated with NOACs: three with direct thrombin inhibitor dabigatran and three with direct factor Xa inhibitor rivaroxaban. National Institutes of Health Stroke Scale score at baseline was 4 (3–7) in the NOAC versus 2 (1–7) in the VKA groups. Complete recanalization at 6 months was seen in most patients in the NOAC (n = 5; 83%) and VKA (n = 34; 55%) groups. All the patients using NOACs had mRS ≤1 at 6 months and none had an intracerebral hemorrhage (ICH). In the VKA group most patients (n = 48; 77%) had mRS ≤1, one patient (1.7%) had an ICH and one died.ConclusionsIn this small, consecutive single-center patient sample treating ischemic stroke patients with CeAD with NOACs did not bring up safety concerns and resulted in similar, good outcomes compared to patients using VKAs.
Highlights
Cervical artery dissection (CeAD) patients with or without stroke are frequently treated with either antiplatelet agents or vitamin K antagonists (VKAs), but few data are reported on the use of nonvitamin K oral anticoagulants (NOACs)
Anticoagulation with nonvitamin K oral anticoagulants (NOACs) is increasingly used for stroke prevention in patients with atrial fibrillation (AF), instead of vitamin K antagonists (VKAs), as both direct factor Xa (Granger et al 2011; Patel et al 2011) and direct thrombin (Connolly et al 2009) inhibitors have been shown to have similar or better safety and efficacy profiles compared with warfarin
There is few data on their use in ischemic stroke patients with CeAD (Caprio et al 2014); and only one report was found with 10 stroke patients using NOACs as the secondary prevention of ischemic stroke
Summary
Cervical arterial dissections (CeAD), that is, vertebral artery (VAD) and internal carotid artery (ICAD) dissections are common etiologies of ischemic stroke in the young (Yesilot Barlas et al 2013). Most physicians prescribe anticoagulants for stroke prevention in acute CeAD, there are no randomized trials comparing the safety and efficacy of anticoagulants with antiplatelets or placebo (Engelter et al 2007; Sarikaya et al 2013). Anticoagulation with nonvitamin K oral anticoagulants (NOACs) is increasingly used for stroke prevention in patients with atrial fibrillation (AF), instead of vitamin K antagonists (VKAs), as both direct factor Xa (Granger et al 2011; Patel et al 2011) and direct thrombin (Connolly et al 2009) inhibitors have been shown to have similar or better safety and efficacy profiles compared with warfarin. There is few data on their use in ischemic stroke patients with CeAD (Caprio et al 2014); and only one report was found with 10 stroke patients using NOACs as the secondary prevention of ischemic stroke
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