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Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?
We describe four cases of CADs and, firstly in literature, cervico-cerebral (CCADs) in young patients (average age of 42  years) treated with rivaroxaban 20 mg daily. Three of these four dissections had affected the vertebral artery (condition with an unfavorable prognosis and more often complicated by subarachnoid hemorrhages), and the other one was a carotid dissection at the extra-intracranial passage. All patien ts were followed clinically and with serial neurosonological examinations at 1, 3, and 6 months and with magnetic resonance angiography (MRA) at 6 months. All patients presented a good outcome with vascular...
Source: Neurological Sciences - April 11, 2019 Category: Neurology Source Type: research

When a Single Antiplatelet Agent for Stroke Prevention Is Not Enough: Current Evidence and Future Applications of Dual Antiplatelet Therapy.
Abstract OPINION STATEMENT: For secondary stroke prevention, long-term dual antiplatelet therapy is not recommended due to increased bleeding risks. There is no specific evidence for using dual antiplatelet therapy for cervical artery dissection or for adding a second antiplatelet agent after a stroke while taking aspirin monotherapy. For patients with atrial fibrillation and stroke/TIA unable to tolerate warfarin, aspirin monotherapy is reasonable. Dual antiplatelet therapy carries a similar risk of major bleeding as warfarin that offsets reductions in stroke risk. Dual antiplatelet therapy is recommended for end...
Source: Atherosclerosis - February 27, 2016 Category: Cardiology Authors: Yuan K, Kim AS Tags: Curr Treat Options Cardiovasc Med Source Type: research

When a Single Antiplatelet Agent for Stroke Prevention Is Not Enough: Current Evidence and Future Applications of Dual Antiplatelet Therapy
Opinion statement For secondary stroke prevention, long-term dual antiplatelet therapy is not recommended due to increased bleeding risks. There is no specific evidence for using dual antiplatelet therapy for cervical artery dissection or for adding a second antiplatelet agent after a stroke while taking aspirin monotherapy. For patients with atrial fibrillation and stroke/TIA unable to tolerate warfarin, aspirin monotherapy is reasonable. Dual antiplatelet therapy carries a similar risk of major b...
Source: Current Treatment Options in Cardiovascular Medicine - February 24, 2016 Category: Cardiology Source Type: research

Potential new uses of non-vitamin K antagonist oral anticoagulants to treat and prevent stroke
Conclusion: There may be a role for NOACs in stroke prevention and treatment beyond atrial fibrillation. Randomized controlled trials are needed to compare NOACs to current stroke prevention and treatment strategies in certain subgroups of patients with cerebrovascular disease.
Source: Neurology - September 21, 2015 Category: Neurology Authors: Yaghi, S., Kamel, H., Elkind, M. S. V. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Infarction, Cerebral venous thrombosis VIEWS & amp;amp; REVIEWS Source Type: research

Comment CADISS: a feasibility trial that answered its question
Anticoagulation after ischaemic stroke was a topic of major controversy for decades until a series of randomised clinical trials consistently showed no net benefit of heparin or warfarin compared with aspirin.1,2 Any reduction in the risk of recurrent ischaemic stroke was offset by an increase in risk of intracerebral haemorrhages. One cause of stroke for which the effect of anticoagulation remains unclear is cervical artery dissection. The classic dogma was that a tear in the intima leads to formation of a fibrin-rich thrombus and poses a very high risk of artery-to-artery embolism or occlusion, making early anticoagulati...
Source: Lancet Neurology - February 12, 2015 Category: Neurology Authors: Scott E Kasner Tags: Comment Source Type: research

Efficacy and Safety of Novel Oral Anticoagulants in Patients with Cervical Artery Dissections
We report on the use, safety, and efficacy of NOACs in the treatment of CAD. Methods: We retrospectively identified patients diagnosed with CAD at a single academic center between January 2010 and August 2013. Patients were categorized by their antithrombotic treatment at hospital discharge with a NOAC (dabigatran, rivaroxaban, or apixaban), traditional anticoagulant (AC: warfarin or treatment dose low-molecular weight heparin), or antiplatelet agent (AP: aspirin, clopidogrel, or aspirin/extended-release dypyridamole). Using appropriate tests, we compared the baseline medical history, presenting clinical symptoms and initi...
Source: Cerebrovascular Diseases - November 12, 2014 Category: Neurology Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research