From the Guidelines
Vertebral Artery Dissection Management
For vertebral artery dissection, single antiplatelet therapy is generally preferred over dual antiplatelet therapy (DAPT) due to the lower risk of bleeding complications 1.
- The recommended treatment typically involves aspirin 81-100 mg daily for a duration of at least 3 to 6 months, as suggested by guidelines for the management of patients with extracranial carotid and vertebral artery disease 1.
- Dual antiplatelet therapy, which includes a combination of aspirin and a P2Y12 inhibitor such as clopidogrel 75 mg daily, may be considered in specific cases, such as those with recurrent ischemic events or significant stenosis, but the benefits and risks should be carefully weighed on an individual basis.
- It's essential to note that the choice between antiplatelet therapy and anticoagulation should be made based on individual patient characteristics and the specific circumstances of the dissection, with antiplatelet therapy being a reasonable option for at least 3 to 6 months in patients with ischemic stroke or TIA associated with extracranial carotid or vertebral arterial dissection 1.
- The guidelines from the world stroke organization also support the use of single antiplatelet agents for secondary stroke prevention in patients with non-cardioembolic ischemic events who do not require oral anticoagulation, including aspirin, clopidogrel, or the combination of aspirin and dipyridamole 1.
From the Research
Treatment Options for Vertebral Artery Dissection
The management of vertebral artery dissection involves the use of antiplatelet or anticoagulant therapy to reduce the risk of recurrent stroke.
- The choice between dual antiplatelet therapy (DAPT) and single antiplatelet therapy is not explicitly addressed in the provided studies, as they primarily compare antiplatelet therapy with anticoagulation therapy.
- However, the studies suggest that antiplatelet therapy is a reasonable treatment option for patients with vertebral artery dissection, with a low risk of recurrent ischemic events 2, 3, 4, 5.
- Anticoagulation therapy is also used in some cases, but the evidence suggests that it may not be more effective than antiplatelet therapy in preventing recurrent stroke, and may be associated with a higher risk of bleeding complications 2, 6, 5.
Comparison of Antiplatelet and Anticoagulant Therapy
- A randomized trial (CADISS) found no difference in efficacy between antiplatelet and anticoagulant therapy in preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection 5.
- Another study found that the rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection 3.
- A study comparing novel oral anticoagulants (NOACs) with traditional anticoagulants and antiplatelet agents found that NOACs may be a reasonable alternative in the management of cervical artery dissection, with similar rates of recurrent stroke and fewer hemorrhagic complications 6.
Predictors of Outcome
- The studies suggest that the risk of recurrent ischemic events in patients with vertebral artery dissection is low, and is not significantly influenced by the type of antithrombotic treatment used 2, 3, 4, 5.
- However, factors such as stroke as the presenting event and severity of stroke at onset may be significant predictors of a poor outcome 2.