Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis.
<h4>Objective</h4>To compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection.<h4>Design</h4>Systematic review with Bayesian meta-analysis.<h4>Data sources</h4>The reviewers searched MEDLINE and...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072697&type=printable |
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| author | Hakan Sarikaya Bruno R da Costa Ralf W Baumgartner Kathleen Duclos Emmanuel Touzé Jean M de Bray Antti Metso Tiina Metso Marcel Arnold Antonio Arauz Marcel Zwahlen Peter Jüni |
| author_facet | Hakan Sarikaya Bruno R da Costa Ralf W Baumgartner Kathleen Duclos Emmanuel Touzé Jean M de Bray Antti Metso Tiina Metso Marcel Arnold Antonio Arauz Marcel Zwahlen Peter Jüni |
| author_sort | Hakan Sarikaya |
| collection | DOAJ |
| description | <h4>Objective</h4>To compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection.<h4>Design</h4>Systematic review with Bayesian meta-analysis.<h4>Data sources</h4>The reviewers searched MEDLINE and EMBASE from inception to November 2012, checked reference lists, and contacted authors.<h4>Study selection</h4>Studies were eligible if they were randomised, quasi-randomised or observational comparisons of antiplatelets and anticoagulants in patients with cervical artery dissection.<h4>Data extraction</h4>Data were extracted by one reviewer and checked by another. Bayesian techniques were used to appropriately account for studies with scarce event data and imbalances in the size of comparison groups.<h4>Data synthesis</h4>Thirty-seven studies (1991 patients) were included. We found no randomised trial. The primary analysis revealed a large treatment effect in favour of antiplatelets for preventing the primary composite outcome of ischaemic stroke, intracranial haemorrhage or death within the first 3 months after treatment initiation (relative risk 0.32, 95% credibility interval 0.12 to 0.63), while the degree of between-study heterogeneity was moderate (τ(2) = 0.18). In an analysis restricted to studies of higher methodological quality, the possible advantage of antiplatelets over anticoagulants was less obvious than in the main analysis (relative risk 0.73, 95% credibility interval 0.17 to 2.30).<h4>Conclusion</h4>In view of these results and the safety advantages, easier usage and lower cost of antiplatelets, we conclude that antiplatelets should be given precedence over anticoagulants as a first line treatment in patients with cervical artery dissection unless results of an adequately powered randomised trial suggest the opposite. |
| format | Article |
| id | doaj-art-0d6513d6977541ef8c0a1407efb4e0e3 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-0d6513d6977541ef8c0a1407efb4e0e32025-08-20T03:29:04ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0189e7269710.1371/journal.pone.0072697Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis.Hakan SarikayaBruno R da CostaRalf W BaumgartnerKathleen DuclosEmmanuel TouzéJean M de BrayAntti MetsoTiina MetsoMarcel ArnoldAntonio ArauzMarcel ZwahlenPeter Jüni<h4>Objective</h4>To compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection.<h4>Design</h4>Systematic review with Bayesian meta-analysis.<h4>Data sources</h4>The reviewers searched MEDLINE and EMBASE from inception to November 2012, checked reference lists, and contacted authors.<h4>Study selection</h4>Studies were eligible if they were randomised, quasi-randomised or observational comparisons of antiplatelets and anticoagulants in patients with cervical artery dissection.<h4>Data extraction</h4>Data were extracted by one reviewer and checked by another. Bayesian techniques were used to appropriately account for studies with scarce event data and imbalances in the size of comparison groups.<h4>Data synthesis</h4>Thirty-seven studies (1991 patients) were included. We found no randomised trial. The primary analysis revealed a large treatment effect in favour of antiplatelets for preventing the primary composite outcome of ischaemic stroke, intracranial haemorrhage or death within the first 3 months after treatment initiation (relative risk 0.32, 95% credibility interval 0.12 to 0.63), while the degree of between-study heterogeneity was moderate (τ(2) = 0.18). In an analysis restricted to studies of higher methodological quality, the possible advantage of antiplatelets over anticoagulants was less obvious than in the main analysis (relative risk 0.73, 95% credibility interval 0.17 to 2.30).<h4>Conclusion</h4>In view of these results and the safety advantages, easier usage and lower cost of antiplatelets, we conclude that antiplatelets should be given precedence over anticoagulants as a first line treatment in patients with cervical artery dissection unless results of an adequately powered randomised trial suggest the opposite.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072697&type=printable |
| spellingShingle | Hakan Sarikaya Bruno R da Costa Ralf W Baumgartner Kathleen Duclos Emmanuel Touzé Jean M de Bray Antti Metso Tiina Metso Marcel Arnold Antonio Arauz Marcel Zwahlen Peter Jüni Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. PLoS ONE |
| title | Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. |
| title_full | Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. |
| title_fullStr | Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. |
| title_full_unstemmed | Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. |
| title_short | Antiplatelets versus anticoagulants for the treatment of cervical artery dissection: Bayesian meta-analysis. |
| title_sort | antiplatelets versus anticoagulants for the treatment of cervical artery dissection bayesian meta analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072697&type=printable |
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