Objective To explore the impact of antithrombotic therapy discontinuation in the postacute phase of cervical artery dissection (CeAD) on the mid-term outcome of these patients.
Methods In a cohort of consecutive patients with first-ever CeAD, enrolled in the setting of the multicentre Italian Project on Stroke in Young Adults Cervical Artery Dissection, we compared postacute (beyond 6 months since the index CeAD) outcomes between patients who discontinued antithrombotic therapy and patients who continued taking antithrombotic agents during follow-up. Primary outcome was a composite of ischaemic stroke and transient ischaemic attack. Secondary outcomes were (1) Brain ischaemia ipsilateral to the dissected vessel and (2) Recurrent CeAD. Associations with the outcome of interest were assessed by the propensity score (PS) method.
Results Of the 1390 patients whose data were available for the outcome analysis (median follow-up time in patients who did not experience outcome events, 36.0 months (25th–75th percentile, 62.0)), 201 (14.4%) discontinued antithrombotic treatment. Primary outcome occurred in 48 patients in the postacute phase of CeAD. In PS-matched samples (201 vs 201), the incidence of primary outcomes among patients taking antithrombotics was comparable with that among patients who discontinued antithrombotics during follow-up (5.0% vs 4.5%; p(log rank test)=0.526), and so was the incidence of the secondary outcomes ipsilateral brain ischaemia (4.5% vs 2.5%; p(log rank test)=0.132) and recurrent CeAD (1.0% vs 1.5%; p(log rank test)=0.798).
Conclusions Discontinuation of antithrombotic therapy in the postacute phase of CeAD does not appear to increase the risk of brain ischaemia during follow-up.
- CEREBROVASCULAR DISEASE
- CLINICAL NEUROLOGY
Data availability statement
Data are available upon reasonable request.
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Contributors AP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: DP, MG, AP. Acquisition of data: All authors. Interpretation of data: DP, MG, AP. Drafting of the manuscript: DP, AP. Critical revision of the manuscript for important intellectual content: All authors. Data analysis: DP, MG, AP. Statistical analysis: MG, AP. Administrative, technical, or material support: AP. Study supervision: AP.
Funding The Italian Project on Stroke in Young Adults (IPSYS) is supported by a grant from the Associazione per la Lotta alla Trombosi e alle Malattie Cardiovascolari (ALT).
Disclaimer The Associazione per la Lotta alla Trombosi e alle Malattie Cardiovascolari (ALT) had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.
Competing interests AZ reports personal fees from Boehringer-Ingelheim, personal fees from Medtronic, personal fees from Cerenovus, and personal fees from Stryker outside the submitted work. CL reports personal fees from Daiichi Sankio, personal fees from Boehringer Ingelheim, and personal fees from Bayer Healthcare outside the submitted work. MP reports Bayer speaker bureau, Boerinhger speaker bureau, Pfizer speaker bureau, Daiiki Sankyo speaker bureau, BMS speaker bureau, Sanofi speaker bureau, the Italian Ministry of Heatlh Ricerca Corrente – IRCCS MultiMedica.
Provenance and peer review Not commissioned; externally peer reviewed.
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