Novel oral anticoagulants as good as warfarin in managing cervical artery dissection: Study

USA: Novel oral anticoagulants have comparable efficacy and safety compared to vitamin K antagonists for stroke prevention in cervical artery dissection, highlights a study report published in the European Stroke Journal.

Cervical artery dissection represents a unique clinical entity triggered by an intimal tear between the inner and medial layers of the wall of extracranial carotid or vertebral arteries due to poorly identified multifactorial mechanisms. Cervical artery dissection is one of the leading causes of stroke in the young adult population and has an incidence rate of 2.6–3.0 per 100,000 population. Prompt management of cervical artery dissection is crucial to prevent further ischemic events potentially leading to disabling neurological deficits.

Vitamin K antagonists showed good efficacy in cervical artery dissection management but are inconvenient to use because of their potentially higher bleeding rates. Novel oral anticoagulants are easier to use and may have similar effects but lower hemorrhagic risk.

Muhammed Amir Essibayi, Department of Neurologic Surgery, Mayo Clinic, USA, and his research team conducted a pooled analysis of small-scale studies and two large clinical trials to compare the efficacy and safety of novel oral anticoagulants with those of warfarin in cervical artery dissection.

Researchers searched Pubmed, PMC, and Embase databases for studies evaluating both Novel oral anticoagulants and Vitamin K antagonists. Baseline characteristics, clinical and radiographic outcomes, and hemorrhagic and ischemic complications were collected for single and double-arm studies and analyzed using a random-effect subgroup meta-analysis. Overall, 11 studies were included with 699 patients treated with Vitamin K antagonists and 53 treated with Novel oral anticoagulants. There was no statistical difference in the baseline characteristics of Vitamin K antagonists and novel oral anticoagulants patients

Key findings of the analysis,

• The incidence rates of transient ischemic attacks/stroke in Vitamin K antagonists and novel oral anticoagulants groups were 12.3% and 5.7%, respectively.

• Novel oral anticoagulants groups had a lower incidence rate of major bleeding (0.0% vs 1.2%).

• Lesions treated with Vitamin K antagonists showed angiographic recanalization with a rate of 51.4% and for those treated with NOAC was 58.4%.

• The rates of good clinical outcomes(defined by an mRS score of 0–2) were 79.9% in the Vitamin K antagonists group and 91.4% in Novel oral anticoagulants. However, there was no statistically significant difference in any of the outcomes between the two treatment groups.

The authors conclude that in addition to the low risk of hemorrhagic complications and the convenient usage, novel oral anticoagulants have comparable efficacy to vitamin K antagonists in stroke prevention after cervical artery dissection. However, further head-to-head clinical trials are needed to validate these findings.

Reference:

Essibayi MA, Lanzino G, Keser Z. Vitamin K antagonist versus novel oral anticoagulants for management of cervical artery dissection: Interactive systematic review and meta-analysis. European Stroke Journal. July 2022. doi:10.1177/23969873221111051