title: Antithrombotic treatment for acute extracranial carotid artery dissections: a meta-analysis.
abstract: BACKGROUND
  Carotid artery dissection is a leading cause of stroke in younger patients, with an associated prevalence of 2.6-3.0 per 100,000 population. This meta-analysis aims to determine whether in patients managed medically, treatment with anticoagulants or antiplatelet agents was associated with a better outcome with respect to mortality, ischaemic stroke, and major bleeding episodes.
  
  
  METHODS
  A comprehensive search strategy was employed of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to March 2015), and EMBASE (January 1980 to March 2015) databases. Primary outcomes were death (all causes) or disability. Secondary outcomes were ischaemic stroke, symptomatic intracranial haemorrhage, and major extracranial haemorrhage during the reported follow-up period.
  
  
  RESULTS
  No completed randomized trials were found. Comparing antiplatelets with anticoagulants across 38 studies (1,398 patients), there were no significant differences in the odds of death (effects size, ES, -0.007, p = .871), nor in the death and disability comparison or across any secondary outcomes.
  
  
  CONCLUSIONS
  There were no randomised trials comparing either anticoagulants or antiplatelets with control, thus there is no level 1 evidence to support their routine use for the treatment of carotid artery dissection. Also, there were no randomised trials that directly compared anticoagulants with antiplatelet drugs, and the reported non-randomised studies did not show any evidence of a significant difference between the two.
authors.affiliation: Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK. Electronic address: mo.chowdhury@doctors.org.uk.
authors.forename: M M
authors.initials: MM
authors.lastname: Chowdhury
authors.affiliation: Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK.
authors.forename: C N
authors.initials: CN
authors.lastname: Sabbagh
authors.affiliation: MRC Biostatistics Unit, Cambridge Biomedical Campus, Institute of Public Health, Cambridge, UK.
authors.forename: D
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Coughlin
authors.affiliation: Division of Vascular and Endovascular Surgery, University Hospital of South Manchester, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ghosh
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Antithrombotic; Extracranial carotid dissections