■颈动脉夹层是年轻人中风的最常见原因。迄今为止,目前尚无确凿的证据表明哪些抗血栓治疗应该用于治疗患者.
■对比较抗凝药和抗血小板预防颈动脉夹层后卒中的随机临床试验进行个体患者数据荟萃分析。
■PubMed.gov,Cochrane数据库,Embase,和ClinicalTrials.gov从成立到2023年8月1日进行了搜索。
■研究颈动脉夹层患者抗血栓治疗(抗血小板与抗凝)的有效性和安全性的随机临床试验纳入荟萃分析。主要终点要求包括(1)任何行程,(2)死亡,或(3)大出血(颅外或颅内)在90天的随访。
两名独立研究人员根据系统评价和荟萃分析指南的首选报告项目进行了系统评价,不一致的问题由主要研究者解决。
■主要结局是(1)缺血性卒中,(2)死亡,或(3)大出血(颅外或颅内)在90天的随访。复合结局的组成部分也是次要结局。进行了基于基线特征的亚组分析,并假定其与结果相关。使用最大惩罚似然法进行Logistic回归,包括亚组分析中的相互作用。
■两项随机临床试验,中风中的颈动脉夹层研究和中风中的颈动脉夹层研究以及颈动脉夹层的生物标志物和抗栓治疗,被确认,所有参与者都有资格参加。共有444名患者纳入意向治疗人群,370名患者纳入符合方案人群。基线特征是平衡的。在随机接受抗凝治疗的患者中,主要终点较少(218中的3个[1.4%]与226中的10个[4.4%];比值比[OR],0.33[95%CI,0.08-1.05];P=.06),但这一发现没有统计学意义.与阿司匹林相比,抗凝与较少的卒中相关(218中的1例[0.5%]与226中的10例[4.0%];或,0.14[95%CI,0.02-0.61];P=0.01)和更多的出血事件(2vs0)。
■对2个目前可用的随机临床试验数据进行的个体患者数据荟萃分析发现,抗凝剂和抗血小板在预防早期复发事件方面没有显着差异。
UNASSIGNED: Cervical artery dissection is the most common cause of stroke in younger adults. To date, there is no conclusive evidence on which antithrombotic therapy should be used to treat patients.
UNASSIGNED: To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection.
UNASSIGNED: PubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023.
UNASSIGNED: Randomized clinical trials that investigated the effectiveness and safety of antithrombotic treatment (antiplatelets vs anticoagulation) in patients with cervical artery dissection were included in the meta-analysis. The primary end point was required to include a composite of (1) any stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up.
UNASSIGNED: Two independent investigators performed a systematic
review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inconsistencies were resolved by a principal investigator.
UNASSIGNED: The primary outcome was a composite of (1) ischemic stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up. The components of the composite outcome were also secondary outcomes. Subgroup analyses based on baseline characteristics with a putative association with the outcome were performed. Logistic regression was performed using the maximum penalized likelihood method including interaction in the subgroup analyses.
UNASSIGNED: Two randomized clinical trials, Cervical Artery Dissection in Stroke Study and Cervical Artery Dissection in Stroke Study and the Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection, were identified, of which all participants were eligible. A total of 444 patients were included in the intention-to-treat population and 370 patients were included in the per-protocol population. Baseline characteristics were balanced. There were fewer primary end points in those randomized to anticoagulation vs antiplatelet therapy (3 of 218 [1.4%] vs 10 of 226 [4.4%]; odds ratio [OR], 0.33 [95% CI, 0.08-1.05]; P = .06), but the finding was not statistically significant. In comparison with aspirin, anticoagulation was associated with fewer strokes (1 of 218 [0.5%] vs 10 of 226 [4.0%]; OR, 0.14 [95% CI, 0.02-0.61]; P = .01) and more bleeding events (2 vs 0).
UNASSIGNED: This individual patient data meta-analysis of 2 currently available randomized clinical trial data found no significant difference between anticoagulants and antiplatelets in preventing early recurrent events.