Aspirin not to be preferred over vitamin K antagonists for cervical artery dissection: Study

Switzerland: Aspirin is not non-inferior to vitamin K antagonists for the treatment of cervical artery dissection -- a major cause of stroke among young people aged below 50 years, finds a recent study in the journal Lancet Neurology.

For the treatment of cervical artery dissection, clinicians have preferred the use of oral anticoagulation with vitamin K antagonists. However, based on available evidence from mostly observational studies, some current guidelines have suggested the use of aspirin. If proven to be non-inferior to vitamin K antagonists, aspirin might be preferable, due to its ease of use and lower cost. Prof Stefan T Engelter, University Hospital Basel and University of Basel, Basel, Switzerland, and colleagues, therefore, aimed to test the non-inferiority of aspirin to vitamin K antagonists in patients with cervical artery dissection.

For this purpose, the researchers performed a multicentre, randomized, open-label, non-inferiority trial in ten stroke centres across Switzerland, Germany, and Denmark. It included 194 patients aged older than 18 years who had symptomatic, MRI-verified, cervical artery dissection within 2 weeks before enrolment. They were randomly assigned in the ratio of 1:1 to receive either aspirin 300 mg once daily (n=100) or a vitamin K antagonist (n=94) (phenprocoumon, acenocoumarol, or warfarin; target international normalized ratio [INR] 2·0–3·0) for 90 days.