title: Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients.
abstract: BACKGROUND
  No randomized study has yet compared efficacy and safety of aspirin and anticoagulants in patients with spontaneous dissection of the cervical carotid artery (sICAD).
  
  
  METHODS
  Prospectively collected data from 298 consecutive patients with sICAD (56% men; mean age 46 +/- 10 years) treated with anticoagulants alone (n = 202) or aspirin alone (n = 96) were retrospectively analyzed. Admission diagnosis was ischemic stroke in 165, TIA in 37, retinal ischemia in 8, and local symptoms and signs (headache, neck pain, Horner syndrome, cranial nerve palsy) in 80 patients, while 8 patients were asymptomatic. Clinical follow-up was obtained after 3 months by neurologic examination (97% of patients) or structured telephone interview. Outcome measures were 1) new cerebral ischemic events, defined as ischemic stroke, TIA, or retinal ischemia, 2) symptomatic intracranial hemorrhage, and 3) major extracranial bleeding.
  
  
  RESULTS
  During follow-up, ischemic events were rare (ischemic stroke, 0.3%; TIA, 3.4%; retinal ischemia, 1%); their frequency did not significantly differ between patients treated with anticoagulants (5.9%) and those treated with aspirin (2.1%). The same was true for hemorrhagic adverse events (anticoagulants, 2%; aspirin, 1%). New ischemic events were significantly more frequent in patients with ischemic events at onset (6.2%) than in patients with local symptoms or asymptomatic patients (1.1%).
  
  
  CONCLUSIONS
  Within the limitations of a nonrandomized study, our data suggest that frequency of new cerebral and retinal ischemic events in patients with spontaneous dissection of the cervical carotid artery is low and probably independent of the type of antithrombotic treatment (aspirin or anticoagulants).
authors.affiliation: Department of Neurology, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland. dimitrios.georgiadis@usz.ch
authors.forename: D
authors.initials: D
authors.lastname: Georgiadis
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: H C
authors.initials: HC
authors.lastname: von Buedingen
authors.forename: P
authors.initials: P
authors.lastname: Valko
authors.forename: H
authors.initials: H
authors.lastname: Sarikaya
authors.forename: V
authors.initials: V
authors.lastname: Rousson
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
authors.forename: M G
authors.initials: MG
authors.lastname: Bousser
authors.forename: R W
authors.initials: RW
authors.lastname: Baumgartner