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Antithrombotic therapy in the postacute phase of cervical artery dissection: the Italian Project on Stroke in Young Adults Cervical Artery Dissection. 2022
Debora Pezzini, and
Mario Grassi, and
Maria Luisa Zedde, and
Andrea Zini, and
Anna Bersano, and
Carlo Gandolfo, and
Giorgio Silvestrelli, and
Claudio Baracchini, and
Paolo Cerrato, and
Corrado Lodigiani, and
Simona Marcheselli, and
Maurizio Paciaroni, and
Maurizia Rasura, and
Manuel Cappellari, and
Massimo Del Sette, and
Anna Cavallini, and
Andrea Morotti, and
Giuseppe Micieli, and
Enrico Maria Lotti, and
Maria Luisa Delodovici, and
Mauro Gentile, and
Mauro Magoni, and
Cristiano Azzini, and
Maria Vittoria Calloni, and
Elisa Giorli, and
Massimiliano Braga, and
Paolo La Spina, and
Fabio Melis, and
Rossana Tassi, and
Valeria Terruso, and
Rocco Salvatore Calabrò, and
Valeria Piras, and
Alessia Giossi, and
Martina Locatelli, and
Valentina Mazzoleni, and
Sandro Sanguigni, and
Carla Zanferrari, and
Marina Mannino, and
Irene Colombo, and
Carlo Dallocchio, and
Patrizia Nencini, and
Valeria Bignamini, and
Alessandro Adami, and
Paolo Costa, and
Rita Bella, and
Rosario Pascarella, and
Alessandro Padovan, and
Alessandro Pezzini, and
Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
To explore the impact of antithrombotic therapy discontinuation in the postacute phase of cervical artery dissection (CeAD) on the mid-term outcome of these patients. In a cohort of consecutive patients with first-ever CeAD, enrolled in the setting of the multicentre Italian Project on Stroke in Young Adults Cervical Artery Dissection, we compared postacute (beyond 6 months since the index CeAD) outcomes between patients who discontinued antithrombotic therapy and patients who continued taking antithrombotic agents during follow-up. Primary outcome was a composite of ischaemic stroke and transient ischaemic attack. Secondary outcomes were (1) Brain ischaemia ipsilateral to the dissected vessel and (2) Recurrent CeAD. Associations with the outcome of interest were assessed by the propensity score (PS) method. Of the 1390 patients whose data were available for the outcome analysis (median follow-up time in patients who did not experience outcome events, 36.0 months (25th-75th percentile, 62.0)), 201 (14.4%) discontinued antithrombotic treatment. Primary outcome occurred in 48 patients in the postacute phase of CeAD. In PS-matched samples (201 vs 201), the incidence of primary outcomes among patients taking antithrombotics was comparable with that among patients who discontinued antithrombotics during follow-up (5.0% vs 4.5%; p(log rank test)=0.526), and so was the incidence of the secondary outcomes ipsilateral brain ischaemia (4.5% vs 2.5%; p(log rank test)=0.132) and recurrent CeAD (1.0% vs 1.5%; p(log rank test)=0.798). Discontinuation of antithrombotic therapy in the postacute phase of CeAD does not appear to increase the risk of brain ischaemia during follow-up.
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Alessia Giossi, and
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Valentina Mazzoleni, and
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