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(Stroke. 2004;35:613.)
© 2004 American Heart Association, Inc.

Cochrane Corner

Antithrombotic Drugs for Carotid Artery Dissection

From the Neurological Clinic and Stroke Unit, University Hospital, Basel, Switzerland.

Correspondence to Philippe Lyrer, MD, Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, CH–4031 Basel, Switzerland. E-mail plyrer@uhbs.ch

Key Words: anticoagulants • antiplatelet agents • carotid artery, internal, dissection • review literature • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Extracranial internal carotid artery dissection can lead to occlusion of the artery and hence cause an ischemic stroke. It is the underlying stroke mechanism in approximately 2.5% of all strokes. It is the second leading cause of stroke in patients younger than 45 years of age. Anticoagulants or antiplatelets may prevent arterial thrombosis in extracranial internal carotid artery dissection, but these benefits may be offset by increased bleeding.

Objectives

To determine whether antithrombotic drugs (antiplatelet drugs, anticoagulation) are effective and safe in treatment of patients with extracranial internal carotid artery dissection (eICAD), and which is the better treatment.

Search Strategy

We searched the Cochrane Stroke Group Trials Register (last searched October 3, 2002). In addition we performed comprehensive searches of the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2002), MEDLINE (January 1966 to May 2002), and EMBASE (January 1980 to June 2002), and checked all relevant papers for additional eligible studies.

Selection Criteria

Randomized controlled trials, controlled clinical trials assessing the efficacy of anticoagulants or antiplatelets for the treatment of extracranial internal carotid artery dissection, and nonrandomized trials, eg, case series (studies), that reported on any antithrombotic treatment with at least 4 patients, were eligible to be analyzed. Data from all eligible studies were extracted independently by 2 reviewers. Disagreements were resolved by discussion.

Data Collection and Analysis

Data on the primary outcome measures were extracted systematically. These were death (all causes) and death or disability. Secondary outcomes were first stroke occurrence, stroke recurrence, any stroke during reported follow-up, extracranial hemorrhage, and intracranial hemorrhage. The first . . . [Full Text of this Article]

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