Recurrent stroke risk high after cervical artery dissection
MedWire News: Patients who suffer stroke or transient ischemic attack (TIA) owing to cervical artery dissection are at high risk for a repeat event, show findings from the German Stroke Study Collaboration.
Cervical artery dissection is rare overall, but nevertheless accounts for 10-20% of strokes in young adults, say Christian Weimar (University of Duisburg-Essen) and colleagues in the Journal of Neurology, Neurosurgery, and Psychiatry.
Between 2002 and 2006, 250 patients were admitted to 30 German acute stroke units with stroke or TIA that was found to be caused by cervical artery dissection.
Thirteen (5.2%) of these patients suffered a recurrent stroke while still in hospital. Fourteen of 198 patients who had long-term follow-up suffered stroke during the next 3 years, giving 1- and 3-year cumulative stroke rates of 10.7% and 14.0%, respectively.
Most - 61.6% - patients were given oral anticoagulation at discharge, while 14.7% were given high-dose heparin, and 3.6% received low-molecular-weight heparin. A further 13.1% were given antiplatelets only, and 6.9% received low-dose heparin or no medication.
Notably, the rate of stroke or TIA recurrence was 2.0% among 98 patients who remained on anticoagulation for at least 6 months, compared with 16.7% among the 18 patients who received antiplatelets only. This association was independent of age; however, one patient suffered intracerebral hemorrhage while taking anticoagulation.
The researchers stress that these findings arise from an observational study, and no randomized trial has yet assessed the benefits of anticoagulation versus antiplatelets in patients with cervical artery dissection.
"Despite our finding of a lower rate of stroke recurrence over 6 months in patients discharged on anticoagulants compared with antiplatelets, the potential benefit of anticoagulation over antiplatelets in cervical artery dissection patients remains unproven," they conclude.
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By Eleanor McDermid