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Antithrombotic therapy in the postacute phase of cervical artery dissection: the Italian Project on Stroke in Young Adults Cervical Artery Dissection
  1. Debora Pezzini1,
  2. Mario Grassi2,
  3. Maria Luisa Zedde3,
  4. Andrea Zini4,
  5. Anna Bersano5,
  6. Carlo Gandolfo6,
  7. Giorgio Silvestrelli7,
  8. Claudio Baracchini8,
  9. Paolo Cerrato9,
  10. Corrado Lodigiani10,
  11. Simona Marcheselli11,
  12. Maurizio Paciaroni12,
  13. Maurizia Rasura13,
  14. Manuel Cappellari14,
  15. Massimo Del Sette15,
  16. Anna Cavallini16,
  17. Andrea Morotti17,
  18. Giuseppe Micieli18,
  19. Enrico Maria Lotti19,
  20. Maria Luisa Delodovici20,
  21. Mauro Gentile4,
  22. Mauro Magoni21,
  23. Cristiano Azzini22,
  24. Maria Vittoria Calloni23,
  25. Elisa Giorli24,
  26. Massimiliano Braga25,
  27. Paolo La Spina26,
  28. Fabio Melis27,
  29. Rossana Tassi28,
  30. Valeria Terruso29,
  31. Rocco Salvatore Calabrò30,
  32. Valeria Piras31,
  33. Alessia Giossi32,
  34. Martina Locatelli1,
  35. Valentina Mazzoleni1,
  36. Sandro Sanguigni33,
  37. Carla Zanferrari34,
  38. Marina Mannino35,
  39. Irene Colombo36,
  40. Carlo Dallocchio37,
  41. Patrizia Nencini38,
  42. Valeria Bignamini39,
  43. Alessandro Adami40,
  44. Paolo Costa41,
  45. Rita Bella42,
  46. Rosario Pascarella43,
  47. Alessandro Padovan1,
  48. Alessandro Pezzini1
  49. on behalf of the Italian Project on Stroke in Young Adults – Cervical Artery Dissection (IPSYS CeAD) Research Group
  1. 1Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia
  2. 2Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia
  3. 3S.C Neurologia, Stroke Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italia
  4. 4UOC Neurologia e Rete Stroke metropolitana, IRCCS Istituto di Scienze Neurologiche di Bologna, Ospedale Maggiore, Bologna, Italia
  5. 5U.O Malattie Cerebrovascolari, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milano, Italia
  6. 6Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia
  7. 7Stroke Unit, Dipartimento di Neuroscienze, Ospedale "Carlo Poma", Mantova, Italia
  8. 8UOSD Stroke Unit e Laboratorio di Neurosonologia, Azienda Ospedale-Università Padova, Padova, Italia
  9. 9Stroke Unit, Dipartimento di Neuroscienze, Ospedale Molinette, Università di Torino, Torino, Italia
  10. 10Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano, Italia
  11. 11Neurologia d'urgenza e Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Italia
  12. 12Internal, Vascular and Emergency Medicine - Stroke Unit, Università degli Studi di Perugia - Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italia
  13. 13Stroke Unit, Azienda Ospedaliera "Sant'Andrea", Università "La Sapienza", Roma, Italia
  14. 14Sroke Unit, Azienda Ospedaliera Universitaria Integrata Borgo Trento, Verona, Italia
  15. 15U,O Neurologia, IRCCS Ospedale Policlinico "San Martino", Genova, Italia
  16. 16U.O Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale "C. Mondino", Pavia, Italia
  17. 17Dipartimento di Scienze Neurologiche e della Visione, ASST Spedali Civili, Brescia, Italia
  18. 18Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale "C. Mondino", Pavia, Italia
  19. 19U.O.C. Neurologia, AUSL Romagna, Ravenna, Italia
  20. 20U.O. Neurologia, Ospedale di Circolo, Università di Varese, Varese, Italia
  21. 21Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, ASST Spedali Civili di Brescia, Brescia, Italia
  22. 22U.O. Neurologia, Stroke Unit, Azienda Ospedaliera "S. Anna", Università di Ferrara, Ferrara, Italia
  23. 23U.O Neurologia, Stroke Unit, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italia
  24. 24U.O Neurologia, Ospedale "Sant'Andrea", La Spezia, Italia
  25. 25U.O.C Neurologia, ASST Vimercate, Vimercate, Italia
  26. 26U.O.S.D Stroke Unit, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italia
  27. 27S.S Neurovascolare, ASL Città di Torino, Ospedale "Maria Vittoria", Torino, Italia
  28. 28U.O.C Stroke Unit, Dipartimento di Scienze Mediche, Azienda Ospedaliera Universitaria Senese, Policlinico “Santa Maria alle Scotte”, Siena, Italia
  29. 29U.O Neurologia, Ospedale "Villa Sofia", Palermo, Italia
  30. 30IRCCS Centro Neurolesi - Bonino-Pulejo, Messina, Italia
  31. 31S.C Neurologia e Stroke Unit, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliera "G. Brotzu", Cagliari, Italia
  32. 32U.O Neurologia, Istituti Ospedalieri, ASST Cremona, Cremona, Italia
  33. 33Dipartimento di Neurologia, Ospedale "Madonna del Soccorso", San Benedetto del Tronto, Italia
  34. 34U.O.C Neurologia - Stroke Unit, ASST Melegnano-Martesana, Vizzolo Predabissi, Italia
  35. 35Stroke Unit, Ospedale Civico Palermo, Palermo, Italia
  36. 36S.C Neurologia e Unità Neurovascolare, Ospedale di Desio, ASST Brianza, Desio, Italia
  37. 37Dipartimento di Area Medica, U.O.C Neurologia, Ospedale Civile di Voghera, ASST Pavia, Voghera, Italia
  38. 38Stroke Unit, Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italia
  39. 39U.O Neurologia, Stroke Unit, Ospedale "S. Chiara", APSS Trento, Trento, Italia
  40. 40Dipartimento di Neurologia, Stroke Center, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italia
  41. 41U.O Neurologia, Istituto Ospedaliero Poliambulanza, Brescia, Italia
  42. 42Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Sezione di Neuroscienze, Università di Catania, Catania, Italia
  43. 43S.S.D Neuroradiologia, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italia
  1. Correspondence to Professor Alessandro Pezzini, Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; alessandro.pezzini{at}unibs.it

Abstract

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
  • STROKE
  • CLINICAL NEUROLOGY

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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