Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections
BackgroundThis study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD).MethodsThis study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated wi...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1469697/full |
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| author | Seong-Joon Lee Min Kim So Young Park Ji Hyun Park Bumhee Park Bumhee Park Woo Sang Jung Jin Wook Choi Yong Cheol Lim Ji Man Hong Jin Soo Lee |
| author_facet | Seong-Joon Lee Min Kim So Young Park Ji Hyun Park Bumhee Park Bumhee Park Woo Sang Jung Jin Wook Choi Yong Cheol Lim Ji Man Hong Jin Soo Lee |
| author_sort | Seong-Joon Lee |
| collection | DOAJ |
| description | BackgroundThis study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD).MethodsThis study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated with anti-thrombotics. Patients were dichotomized to AC and AP based on a treatment policy analysis. Primary endpoints were a composite of ischemic early neurological deterioration, recurrent ischemic or hemorrhagic stroke, or 3-month mortality. Arterial changes were evaluated both in the early (during admission) and late (after discharge) periods. A treatment effectiveness analysis was also performed with AC, AP and a third group of antithrombotic cross-overs. Propensity score matching (PSM) was used to adjust significant baseline differences.ResultsIn unruptured IAD patients (N = 311), the AC group (N = 211) presented with a higher rate of ischemic stroke or TIA (74.4% vs. 51.0%, p < 0.001) and steno-occlusive morphology (vs. dilatation, 63.0% vs. 39.0%, p < 0.001) compared to AP group (N = 100). After PSM, there was no difference in rates of primary endpoint (9.4% vs. 6.5%, p = 0.470). The results of the treatment effectiveness analysis resembled that of the treatment policy analysis. However, there was a high rate of cross-overs from AC to AP (57/211 [27.0%]). In this group, there was a higher rate of early arterial changes (26.8% vs. 13.1%, p = 0.019) compared to the AC group.ConclusionIn patients with unruptured IAD, this study did not show differences in primary endpoints according to antithrombotic regimen, while there was a high rate of cross-overs from AC to AP. |
| format | Article |
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| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-28c6ccf51e6b4ea5b7bc9caacfeb81c02025-08-20T02:30:23ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-12-011510.3389/fneur.2024.14696971469697Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissectionsSeong-Joon Lee0Min Kim1So Young Park2Ji Hyun Park3Bumhee Park4Bumhee Park5Woo Sang Jung6Jin Wook Choi7Yong Cheol Lim8Ji Man Hong9Jin Soo Lee10Department of Neurology, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Neurology, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Neurology, Ajou University School of Medicine, Suwon, Republic of KoreaOffice of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of KoreaOffice of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of KoreaDepartment of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Radiology, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Radiology, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Neurology, Ajou University School of Medicine, Suwon, Republic of KoreaDepartment of Neurology, Ajou University School of Medicine, Suwon, Republic of KoreaBackgroundThis study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD).MethodsThis study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated with anti-thrombotics. Patients were dichotomized to AC and AP based on a treatment policy analysis. Primary endpoints were a composite of ischemic early neurological deterioration, recurrent ischemic or hemorrhagic stroke, or 3-month mortality. Arterial changes were evaluated both in the early (during admission) and late (after discharge) periods. A treatment effectiveness analysis was also performed with AC, AP and a third group of antithrombotic cross-overs. Propensity score matching (PSM) was used to adjust significant baseline differences.ResultsIn unruptured IAD patients (N = 311), the AC group (N = 211) presented with a higher rate of ischemic stroke or TIA (74.4% vs. 51.0%, p < 0.001) and steno-occlusive morphology (vs. dilatation, 63.0% vs. 39.0%, p < 0.001) compared to AP group (N = 100). After PSM, there was no difference in rates of primary endpoint (9.4% vs. 6.5%, p = 0.470). The results of the treatment effectiveness analysis resembled that of the treatment policy analysis. However, there was a high rate of cross-overs from AC to AP (57/211 [27.0%]). In this group, there was a higher rate of early arterial changes (26.8% vs. 13.1%, p = 0.019) compared to the AC group.ConclusionIn patients with unruptured IAD, this study did not show differences in primary endpoints according to antithrombotic regimen, while there was a high rate of cross-overs from AC to AP.https://www.frontiersin.org/articles/10.3389/fneur.2024.1469697/fullintracranial dissectionischemic strokesubarachnoid hemorrhageanticoagulationantiplatelet |
| spellingShingle | Seong-Joon Lee Min Kim So Young Park Ji Hyun Park Bumhee Park Bumhee Park Woo Sang Jung Jin Wook Choi Yong Cheol Lim Ji Man Hong Jin Soo Lee Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections Frontiers in Neurology intracranial dissection ischemic stroke subarachnoid hemorrhage anticoagulation antiplatelet |
| title | Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| title_full | Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| title_fullStr | Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| title_full_unstemmed | Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| title_short | Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| title_sort | comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections |
| topic | intracranial dissection ischemic stroke subarachnoid hemorrhage anticoagulation antiplatelet |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1469697/full |
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