Antiplatelet treatment compared with anticoagulation treatment for cervical XXXX (CADISS): a randomised trial.

@entity1 @entity64 @entity548 @entity510 @entity4048 @entity10 @entity204 @entity4820 @entity4066
BACKGROUND: Extracranial @entity4066 is an important cause of @entity64 , especially in young @entity1 . In some observational studies it has been associated with a high risk of recurrent @entity64 . Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of @entity64 but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical @entity4066 in @entity64 Study (CADISS), with the additional aim of establishing the true risk of recurrent @entity64 . METHODS: We did this randomised trial at hospitals with specialised @entity64 or neurology services (39 in the UK and seven in Australia). We included @entity1 with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. @entity1 were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. @entity1 and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was @entity64 or @entity204 in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). FINDINGS: We enrolled 250 @entity1 (118 carotid, 132 vertebral). Mean time to randomisation was 3  65 days (SD 1  91). The major presenting symptoms were @entity64 or transient ischaemic attack (n=224) and local symptoms ( @entity10 , @entity4048 , or @entity4820 ; n=26). 126 @entity1 were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 @entity1 had @entity64 recurrence (all ipsilateral). @entity64 or @entity204 occurred in three (2%) of 126 @entity1 versus one (1%) of 124 (odds ratio [OR] 0  335, 95% CI 0  006-4  233; p=0  63). There were no deaths, but one major @entity548 ( @entity510 ) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 @entity1 . Preplanned per-protocol analysis excluding these @entity1 showed @entity64 or @entity204 in three (3%) of 101 @entity1 in the antiplatelet group versus one (1%) of 96 @entity1 in the anticoagulant group (OR 0  346, 95% CI 0  006-4  390; p=0  66). INTERPRETATION: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing @entity64 and @entity204 in @entity1 with symptomatic @entity4066 but @entity64 was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. FUNDING: @entity64 Association.
