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Anticoagulation Therapy No Better than Aspirin for Acute Spontaneous Cervical Artery Dissection: Presented at ESC
By Adrian Burton
VALENCIA, SPAIN -- May 22, 2003 -- A study from Mexico shows that patients with cervical artery dissection (CAD) improve just as well on aspirin as they do on anticoagulation treatment.
"In people under 45 [years of age], cervical artery dissection is one of the main causes of cerebral infarction," explained Antonio Arauz, MD, a Stroke Neurologist at the National Institute of Neurology, Mexico City, reporting results here May 22nd at the 2003 European Stroke Conference.
"Standard treatment to prevent thromboembolic complications has long been antiplatelet therapy with aspirin. But in recent years anticoagulation therapy has been recommended. We wanted to see whether there was really any benefit since treatment with aspirin is less complicated and there is less risk of haemorrhage."
The study, which ran from January 1988 till October 2002, involved 91 CAD patients -- 40 with carotid artery and 51 with vertebral artery dissections. Following international treatment recommendations during this period, 79.1% of patients were treated with aspirin 100 – 650 mg/day and 28.1% received anticoagulation therapy with warfarin at international normalised ratio of 2.5.
Patients' functional state at the time of discharge was measured on a modified Rankin scale, with outcome end points being either death, good (0-2 on this scale) or poor recovery (>3 on the scale).
No significant differences were seen in end point outcomes between the two treatments. The only difference detected in outcome was, in fact, between the different types of dissection, with vertebral dissection patients showing better recoveries (P<0.0001; odds ratio 10.97, CI 95% 3.97 – 30.36).
"There were no differences between the two treatment groups in terms of recurrence or functionality [after treatment]," explained Dr. Arauz. "So even though in the last few years anticoagulation therapy has been recommended, it appears to be no better than aspirin for these patients."
"However," he added, "aspirin treatment is less complicated than anticoagulation, which can cause haemorrhaging and requires that patients be periodically monitored -- recording coagulation times, etc. Aspirin would appear to be the better choice. "
[Study title: Anticoagulation Vs Aspirin in the Treatment of Acute Spontaneous Cervical Artery Dissections. Abstract P141]
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