Cervical artery dissection: pathology, epidemiology and management.
BACKGROUND
Cervical artery dissection is often treated with anticoagulants to prevent ischemic stroke. The risk-benefit ratio of anticoagulation versus antiplatelet therapy is unclear.


OBJECTIVE
To provide an educational review of current data on the disease to explain the rationale for the treatment options and to explore the results of management studies in order to determine if anticoagulation is justified.


METHODS
We searched the databases MEDLINE and EMBASE as well as bibliographies for information on anticoagulants and antiplatelet agents in cervical, i.e. carotid and/or vertebral artery, dissection.


RESULTS
There are no randomized controlled trials on the treatment. One systematic review from 2003 identified 20 case series or cohort studies. We identified 9 additional studies with a total of 1,033 patients. Of those, 731 received anticoagulation sometimes followed by platelet inhibition vs. 282 patients treated with antiplatelet agents alone. The rate of ischemic stroke was 2.3% vs. 6.9% and bleeding complications were reported in 0.7% vs. 0%.


CONCLUSIONS
It cannot be excluded that there is a net benefit from anticoagulant therapy in cervical dissection, but the studies are flawed by considerable bias. Very ill patients at a high risk of ischemic stroke may have been given aspirin due to fear of hemorrhagic complications. A randomized controlled trial is planned and will be crucial to resolve this issue.
Kim
Yang-Ki
YK
Department of Medicine, McMaster University, Hamilton ON, Canada.
Schulman
Sam
S
D000925:Anticoagulants / Q000627:therapeutic use; D020215:Carotid Artery, Internal, Dissection / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000235:genetics; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020641:Polymorphism, Single Nucleotide; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology; D015912:Thrombolytic Therapy; D020217:Vertebral Artery Dissection / Q000453:epidemiology / Q000473:pathology / Q000628:therapy
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D018799:Intercellular Adhesion Molecule-1; D042965:Methylenetetrahydrofolate Reductase (NADPH2)