Drugs in R&D ( IF 2.2 ) Pub Date : 2022-08-03 , DOI: 10.1007/s40268-022-00398-z Abdulrahman Ibrahim Hagrass 1 , Bashar Khaled Almaghary 2 , Mohamed Abdelhady Mostafa 3 , Mohamed Elfil 4 , Sarah Makram Elsayed 5 , Amira A Aboali 6 , Aboalmagd Hamdallah 7 , Mohammed Tarek Hasan 1 , Mohammed Al-Kafarna 2 , Khaled Mohamed Ragab 8 , Mohamed Fahmy Doheim 6
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Background and Objectives
In young people aged < 50 years, cervical artery dissection (CeAD) is among the most common causes of stroke. Currently, there is no consensus regarding the safest and most effective antithrombotic treatment for CeAD. We aimed to synthesize concrete evidence from studies that compared the efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for CeAD.
Methods
We searched major electronic databases/search engines from inception till September 2021. Cohort studies and randomized controlled trials (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A meta-analysis was conducted using articles that were obtained and found to be relevant. Mean difference (MD) with 95% confidence interval (CI) was used for continuous data and odds ratio (OR) with 95% CI for dichotomous data.
Results
Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Our analysis showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 95% CI 0.03–7.58), > 3-month mortality (OR 1.63, 95% CI 0.40–6.56), recurrent stroke (OR 0.97, 95% CI 0.46–2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44–1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12–1.19), and complete recanalization (OR 0.70, 95% CI 0.46–1.06). Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs (OR 6.97, 95% CI 1.25–38.83).
Conclusion
Our study did not show a considerable difference between the two groups, as all outcomes showed non-significant differences between them, except for primary ischaemic stroke (RCTs) and complete recanalization (observational studies), which showed a significant favour of AC over AP. Even though primary ischaemic stroke is an important outcome, several crucial points that could affect these results should be paid attention to. These include the incomplete adjustment for the confounding effect of AP–AC doses, frequencies, administration compliance, and others. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CeAD.
中文翻译：
颈动脉夹层治疗中的抗血小板与抗凝治疗：对 2064 名患者的系统回顾和荟萃分析
背景和目标
在 < 50 岁的年轻人中，颈动脉夹层 (CeAD) 是中风的最常见原因之一。目前，对于 CeAD 最安全、最有效的抗血栓治疗尚未达成共识。我们的目的是从比较抗血小板 (AP) 与抗凝 (AC) 疗法治疗 CeAD 的疗效和安全性的研究中综合具体证据。
方法
我们检索了从开始到 2021 年 9 月的主要电子数据库/搜索引擎。其中包括比较抗凝剂与抗血小板治疗 CeAD 的队列研究和随机对照试验 (RCT)。使用获得并发现相关的文章进行荟萃分析。平均差 (MD) 和 95% 置信区间 (CI) 用于连续数据，比值比 (OR) 和 95% CI 用于二分数据。
结果
我们的分析包括 15 项研究，涉及 2064 名患者，其中 909 名患者（44%）接受了抗血小板药物治疗，1155 名患者（56%）接受了抗凝药物治疗。我们的分析显示，3 个月死亡率（OR 0.47，95% CI 0.03–7.58）、> 3 个月死亡率（OR 1.63，95% CI 0.40–6.56）、复发性卒中（OR 0.97，95% CI 0.46–2.02）、复发性短暂性脑缺血发作（TIA）（OR 0.93，95% CI 0.44–1.98）、症状性颅内出血（sICH）（OR 0.38，95% CI 0.12–1.19）和完全再通（OR 0.70，95% CI 0.46–1.06）。关于原发性缺血性卒中，随机对照试验中 AC 的结果优于 AP（OR 6.97，95% CI 1.25-38.83）。
结论
我们的研究没有显示两组之间存在显着差异，因为除了原发性缺血性卒中 (RCT) 和完全再通（观察性研究）之外，所有结果均显示它们之间没有显着差异，这表明 AC 明显优于 AP。尽管原发性缺血性卒中是一个重要的结果，但仍应注意可能影响这些结果的几个关键点。其中包括对 AP-AC 剂量、频率、给药依从性等混杂效应的不完全调整。我们建议进行更多精心设计的研究来评估 CeAD 是否可以避免不必要的抗凝治疗。
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