title: Helsinki experience on nonvitamin K oral anticoagulants for treating cervical artery dissection.
abstract: BACKGROUND
  Cervical artery dissection (CeAD) patients with or without stroke are frequently treated with either antiplatelet agents or vitamin K antagonists (VKAs), but few data are reported on the use of nonvitamin K oral anticoagulants (NOACs).
  
  
  METHODS
  Between November 2011 and January 2014, we recorded data from patients with a stroke due to vertebral (VAD) or internal carotid artery dissection (ICAD). Patients using oral anticoagulants were included in the study and were divided into two treatment groups: patients using NOACs and those using VKAs. Excellent outcome was defined on modified Rankin Scale (mRS) ≤1 at 6 months.
  
  
  RESULTS
  Of 68 stroke patients (67% male; median age 45 [39-53]), six (8.8%; two with VAD and four with ICAD) were treated with NOACs: three with direct thrombin inhibitor dabigatran and three with direct factor Xa inhibitor rivaroxaban. National Institutes of Health Stroke Scale score at baseline was 4 (3-7) in the NOAC versus 2 (1-7) in the VKA groups. Complete recanalization at 6 months was seen in most patients in the NOAC (n = 5; 83%) and VKA (n = 34; 55%) groups. All the patients using NOACs had mRS ≤1 at 6 months and none had an intracerebral hemorrhage (ICH). In the VKA group most patients (n = 48; 77%) had mRS ≤1, one patient (1.7%) had an ICH and one died.
  
  
  CONCLUSIONS
  In this small, consecutive single-center patient sample treating ischemic stroke patients with CeAD with NOACs did not bring up safety concerns and resulted in similar, good outcomes compared to patients using VKAs.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Tiina M
authors.initials: TM
authors.lastname: Metso
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Noora
authors.initials: N
authors.lastname: Heikkinen
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.affiliation: Department of Neuroradiology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Oili
authors.initials: O
authors.lastname: Salonen
authors.affiliation: Department of Neurology, Helsinki University Central Hospital Helsinki, Finland.
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D020215:Carotid Artery, Internal, Dissection / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014812:Vitamin K
keywords: Acute stroke; anticoagulation; cervical arterial dissection