Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections

Abstract

Background: This study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD). Methods: This 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. Results: In 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. Conclusion: In 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.