{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:28:18Z","timestamp":1792578498311,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma. The exposure was antithrombotic treatment type (anticoagulation versus antiplatelets), and outcomes were subsequent ischemic stroke and major hemorrhage (intracranial or extracranial hemorrhage). We used adjusted Cox regression with inverse probability of treatment weighting to determine associations between anticoagulation and study outcomes within 30 and 180 days. The main analysis used an as-treated crossover approach and only included outcomes occurring with the above treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The study included 3636 patients (402 [11.1%] received exclusively anticoagulation and 2453 [67.5%] received exclusively antiplatelets). By day 180, there were 162 new ischemic strokes (4.4%) and 28 major hemorrhages (0.8%); 87.0% of ischemic strokes occurred by day 30. In adjusted Cox regression with inverse probability of treatment weighting, compared with antiplatelet therapy, anticoagulation was associated with a nonsignificantly lower risk of subsequent ischemic stroke by day 30 (adjusted hazard ratio [HR], 0.71 [95% CI, 0.45\u20131.12];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.145) and by day 180 (adjusted HR, 0.80 [95% CI, 0.28\u20132.24];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.670). Anticoagulation therapy was not associated with a higher risk of major hemorrhage by day 30 (adjusted HR, 1.39 [95% CI, 0.35\u20135.45];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.637) but was by day 180 (adjusted HR, 5.56 [95% CI, 1.53\u201320.13];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.009). In interaction analyses, patients with occlusive dissection had significantly lower ischemic stroke risk with anticoagulation (adjusted HR, 0.40 [95% CI, 0.18\u20130.88];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Our study does not rule out the benefit of anticoagulation in reducing ischemic stroke risk, particularly in patients with occlusive dissection. If anticoagulation is chosen, it seems reasonable to switch to antiplatelet therapy before 180 days to lower the risk of major bleeding. Large prospective studies are needed to validate our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.123.045731","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T10:06:25Z","timestamp":1749031585000},"page":"908-918","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection: The STOP-CAD Study"],"prefix":"10.1161","volume":"55","author":[{"given":"Shadi","family":"Yaghi","sequence":"first","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9784-8475","authenticated-orcid":true,"given":"Liqi","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-4698","authenticated-orcid":true,"given":"Daniel","family":"Mandel","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5997-5342","authenticated-orcid":true,"given":"Christopher R.","family":"Leon Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurology, Atrium Health, Charlotte, NC (C.R.L.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-5623","authenticated-orcid":true,"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Massachusetts, Chan Medical School, Worcester (N.H., J. Muppa)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-5862","authenticated-orcid":true,"given":"Jayachandra","family":"Muppa","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Massachusetts, Chan Medical School, Worcester (N.H., J. Muppa)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Affan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omair","family":"Ul Haq Lodhi","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis (M. Affan, O.U.H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-2159","authenticated-orcid":true,"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kateryna","family":"Antonenko","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, University of Bern, Switzerland (M.R.H., K.A., D. Seiffge, M. Arnold)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setareh","family":"Salehi Omran","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Colorado, Denver (S.S.O., R. Crandall)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Crandall","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Colorado, Denver (S.S.O., R. Crandall)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Lester","sequence":"additional","affiliation":[{"name":"Department of Neurology, Weill Cornell Medicine, New York, NY (E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Lopez Mena","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda Manuel Velasco Suarez, Mexico City, Mexico (D.L.M., A. Arauz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Arauz","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda Manuel Velasco Suarez, Mexico City, Mexico (D.L.M., A. Arauz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nehme","sequence":"additional","affiliation":[{"name":"Service de neurologie, Universit\u00e9 Caen Normandie, CHU Caen Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Boulanger","sequence":"additional","affiliation":[{"name":"Service de neurologie, Universit\u00e9 Caen Normandie, CHU Caen Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Touze","sequence":"additional","affiliation":[{"name":"Service de neurologie, Universit\u00e9 Caen Normandie, CHU Caen Normandie, France (A.N., M.B., E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Andre","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Sargento-Freitas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasco","family":"Barata","sequence":"additional","affiliation":[{"name":"Department of Neurology, Coimbra University, Portugal (J.A.S., J.S.-F., V.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Castro-Chaves","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, S\u00e3o Jo\u00e3o University Hospital, Porto, Portugal (P.C.-C., M.T.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, S\u00e3o Jo\u00e3o University Hospital, Porto, Portugal (P.C.-C., M.T.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhib","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Corewell Health, Grand Rapids, MI (M.K., D. Mallic)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Mallick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Rothstein","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Khazaal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia (A.R., O.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefin E.","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan T.","family":"Engelter","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Traenka","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Department of Geriatric Medicine FELIX PLATTER, Department of Clinical Research, University of Basel, Switzerland (J.E.K., S.T.E., C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Aguiar de Sousa","sequence":"additional","affiliation":[{"name":"Stroke Center, Centro Hospitalar Universit\u00e1rio Lisboa Central, and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.A.d.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mafalda","family":"Soares","sequence":"additional","affiliation":[{"name":"Department of Neurology (M. Saores), Centro Hospitalar Universit\u00e1rio Lisboa Central, Lisbon, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (S.R.), Centro Hospitalar Universit\u00e1rio Lisboa Central, Lisbon, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily W.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preet","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalia S.","family":"Field","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Mancini","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada (L.W.Z., P.G., T.S.F., S. Mancini)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa","family":"Metanis","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (I.M., R.R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen R.","family":"Leker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (I.M., R.R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishnu","family":"Dantu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. Mandel, K.P., V.D., K.B., T.B., N.K., F. Khan, C.S., N.M., E.G., K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Brown Medical School, Providence, RI (S. Yaghi, L.S., D. 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