The 6-months follow-up of the TREAT-CAD trial: Aspirin versus anticoagulation for stroke prevention in patients with cervical artery dissection
Year: 2025
Type: article
Abstract: Introduction Cervical artery dissection is a major cause of stroke in the young. The optimal choice and duration of antithrombotic treatment for stroke prevention are debated, particularly beyond 3 months after symptom onset. Patients and methods TREAT-CAD (TREATment of Cervical Artery Dissection) was a randomized controlled trial with blinded outcome assessment comparing non-inferiority of aspirin to anticoagulation (Vitamin-K-antagonists) in participants with symptomatic, Magnetic-Resonance-(MR)-imaging-verified cervical artery dissection. TREAT-CAD could not establish non-inferiority of aspirin to anticoagulation at 3 months. Thereafter participants could continue antithrombotic medication and obtained a standardized assessment of clinical and MR-Imaging outcomes between 3 and 6 months. As crossover to the other treatment arm was possible, we performed an as-treated analysis as main analysis. The main outcomes were new clinical (ischemic stroke, intracranial/major extracranial bleeding, or death) and new MR-Imaging outcomes (ischemic or hemorrhagic brain lesions). Results Among the 122 participants in the as-treated analysis, 3/93 (3.2%) aspirin-treated participants had new clinical (n = 1) and MRI-outcomes (n = 2) between 3 and 6 months while 1/29 (3.4%) anticoagulated participants had an MRI-outcome (n = 1). All outcome events were hemorrhagic while ischemic events were absent. No deaths occurred. This yields an absolute difference of 0.2% (95% CI −8.0% to 7.5%, p = 1.0). Discussion and conclusion During the extended follow-up period of a controlled randomized trial comparing aspirin to anticoagulation in cervical artery dissection, outcomes between 3 and 6 months after randomization occurred rarely, similarly often in both groups and were exclusively hemorrhagic events. Thus, studies balancing benefits versus harms of antithrombotic treatment beyond 3 months are warranted. Registration: ClinicalTrials.gov: NCT02046460. https://clinicaltrials.gov/ct2/show/NCT02046460.
DOI: 10.5167/uzh-284590
Authors: Engelter, Stefan T, Enz, Lukas S, Ravanelli, Flavia, Kaufmann, Josefin E, Gensicke, Henrik, Schaedelin, Sabine, Luft, Andreas R, Globas, Christoph, Goeggel-Simonetti, Barbara, Fischer, Urs, Strambo, Davide, Kägi, Georg, Nedeltchev, Krassen, Kahles, Timo, Kellert, Lars, Rosenbaum, Sverre, von Rennenberg, Regina, Brehm, Alex, Seiffge, David, Renaud, Susanne, Brandt, Tobias, Sarikaya, Hakan, Zietz, Annaelle, Wischmann, Johannes, Polymeris, Alexandros A, Fischer, Sandro, Bonati, Leo H, De Marchis, Gian Marco, Peters, Nils, Nolte, Christian H, Wegener, Susanne, et al
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7127597271
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