title: Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review.
abstract: Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients.
  
  
  
  The objective of this study is to compare antithrombotic treatments in patients with carotid and vertebral dissections.
  
  
  
  Three hundred seventy patients with carotid and vertebral artery dissections were included. Univariate and multivariate analyses were conducted to analyze the association between treatment and new or recurrent events and clinical outcome.
  
  
  
  Mean follow-up was 24.3 months. In patients with spontaneous dissection, 55% received antiplatelets, 29.4% anticoagulation, and 12.6% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 9.6% of patients on antiplatelets, 10.4% on anticoagulation, and 13.3% on combined treatment. For traumatic dissection, 58.3% received antiplatelets, 26.9% anticoagulation, and 10.2% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 6.9% on antiplatelets, 11.1% on anticoagulation, and 20% on combined treatment. In patients with intracranial dissection, 63.1% were started on antiplatelets, 19.7% on anticoagulation, and 14.5% on combined treatment. Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment. In patients with extracranial dissection, 54.4% were on antiplatelets, 28.9% on anticoagulation, and 11.2% on combined treatment. Ischemic and hemorrhagic events occurred in 10.1% on antiplatelet treatment, 9.3% on anticoagulation, and 13.8% on combined treatment. The association between antithrombotic treatment and ischemic/hemorrhagic events and clinical outcome was not significant for all subtypes of dissection.
  
  
  
  The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Emergency Surgery, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mouchtouris
authors.affiliation: Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Koduri
authors.affiliation: The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulation; Antiplatelet; Antithrombotic; Carotid; Dissection; Vertebral