title: Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis.
abstract: OBJECTIVE
  To compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection.
  
  
  METHODS
  Systematic review with Bayesian meta-analysis.
  
  
  METHODS
  The reviewers searched MEDLINE and EMBASE from inception to November 2012, checked reference lists, and contacted authors.
  
  
  METHODS
  Studies were eligible if they were randomised, quasi-randomised or observational comparisons of antiplatelets and anticoagulants in patients with cervical artery dissection.
  
  
  METHODS
  Data were extracted by one reviewer and checked by another. Bayesian techniques were used to appropriately account for studies with scarce event data and imbalances in the size of comparison groups.
  
  
  RESULTS
  Thirty-seven studies (1991 patients) were included. We found no randomised trial. The primary analysis revealed a large treatment effect in favour of antiplatelets for preventing the primary composite outcome of ischaemic stroke, intracranial haemorrhage or death within the first 3 months after treatment initiation (relative risk 0.32, 95% credibility interval 0.12 to 0.63), while the degree of between-study heterogeneity was moderate (τ(2) = 0.18). In an analysis restricted to studies of higher methodological quality, the possible advantage of antiplatelets over anticoagulants was less obvious than in the main analysis (relative risk 0.73, 95% credibility interval 0.17 to 2.30).
  
  
  CONCLUSIONS
  In view of these results and the safety advantages, easier usage and lower cost of antiplatelets, we conclude that antiplatelets should be given precedence over anticoagulants as a first line treatment in patients with cervical artery dissection unless results of an adequately powered randomised trial suggest the opposite.
authors.affiliation: Department of Neurology, University Hospital of Zurich, Zurich, Switzerland ; Department of Neurology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarikaya
authors.forename: Bruno R
authors.initials: BR
authors.lastname: da Costa
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Baumgartner
authors.forename: Kathleen
authors.initials: K
authors.lastname: Duclos
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touzé
authors.forename: Jean M
authors.initials: JM
authors.lastname: de Bray
authors.forename: Antti
authors.initials: A
authors.lastname: Metso
authors.forename: Tiina
authors.initials: T
authors.lastname: Metso
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Antonio
authors.initials: A
authors.lastname: Arauz
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001499:Bayes Theorem; D020215:Carotid Artery, Internal, Dissection / Q000188:drug therapy*; D006801:Humans; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
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