Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/102964
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial |
Author: | CADISS trial investigators, Markus, H. Hayter, E. Levi, C. Feldman, A. Venables, G. Norris, J. Peycke, J. Willson, M. Hicks, C. Hayter, E. Madigan, J. Clifton, A. Menon, R. Kennedy, F. Khan, U. Feldman, A. Hollocks, M. Markus, H. King, A. et al. |
Citation: | Lancet Neurology, 2015; 14(4):361-367 |
Publisher: | Elsevier |
Issue Date: | 2015 |
ISSN: | 1474-4465 1474-4465 |
Statement of Responsibility: | H.S. Markus ... T. Kleinig ... et al. (CADISS trial investigators) |
Abstract: | Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. Methods: We did this randomised trial at hospitals with specialised stroke or neurology services (39 in the UK and seven in Australia). We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. Patients were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. Patients and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was ipsilateral stroke or death in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). Findings: We enrolled 250 participants (118 carotid, 132 vertebral). Mean time to randomisation was 3·65 days (SD 1·91). The major presenting symptoms were stroke or transient ischaemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26). 126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 patients had stroke recurrence (all ipsilateral). Stroke or death occurred in three (2%) of 126 patients versus one (1%) of 124 (odds ratio [OR] 0·335, 95% CI 0·006–4·233; p=0·63). There were no deaths, but one major bleeding (subarachnoid haemorrhage) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 patients. Preplanned per-protocol analysis excluding these patients showed stroke or death in three (3%) of 101 patients in the antiplatelet group versus one (1%) of 96 patients in the anticoagulant group (OR 0·346, 95% CI 0·006–4·390; p=0·66). Interpretation: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. Funding: Stroke Association. |
Keywords: | CADISS trial investigators Spine Arteries Humans Carotid Artery, Internal, Dissection Ischemic Attack, Transient Subarachnoid Hemorrhage Anticoagulants Platelet Aggregation Inhibitors Odds Ratio Adult Aged Middle Aged Female Male Stroke Aortic Dissection |
Rights: | © Markus et al. Open Access article distributed under the terms of CC BY. Open Access funded by British Heart Foundation Under a Creative Commons license |
DOI: | 10.1016/S1474-4422(15)70018-9 |
Published version: | http://dx.doi.org/10.1016/s1474-4422(15)70018-9 |
Appears in Collections: | Aurora harvest 7 Medicine publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
hdl_102964.pdf | Published Version | 273.43 kB | Adobe PDF | View/Open |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.