We compared the efficacy and safety of antiplatelet- and anticoagulant-based therapies for cervical artery dissection (CAD).

In young people aged <50 years, CAD is among the most common causes of stroke. Currently, there is no consensus about the most safe and effective antithrombotic treatment for CAD.

We searched major electronic databases from inception till September 2021. We included cohort studies and randomized controlled trials (RCTs) comparing anticoagulants and antiplatelets in CAD.

Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Achieving functional independence (modified Rankin Scale score, 0-2) was not of statistically significant difference at 6 months (OR = 0.75, 95% CI [0.47, 1.21]). Both therapies had similar results in terms of TIA across RCTs (OR =  0.37, 95% CI [0.08, 1.59]) and cohort studies (OR = 0.74, 95% CI [0.20, 2.76]), complete recanalization (OR = 0.70, 95% CI [0.46, 1.06]), recurrent stroke (OR = 0.87, 95% CI [0.40, 1.89]), recurrent TIA (OR = 1.01, 95% CI [0.41, 2.47]), 3 months mortality (OR = 0.47, 95% CI [0.03, 7.58]), > 3 months mortality (OR =1.63, 95% CI [0.40, 6.56]), symptomatic ICH (OR = 0.38, 95% CI [0.12, 1.19]), major extracranial bleeding (OR = 0.45, 95% CI [0.09, 2.30]), all hemorrhagic complications (OR = 0.39, 95% CI [0.08, 1.80]), seizure (OR = 1.00, 95% CI [0.23, 4.40]), total adverse events (OR = 0.60, 95% CI [0.32, 1.15]), new ischemic lesions detected by diffusion-weighted imaging (DWI) (OR = 0.78, 95% CI [0.25, 2.40]), and MRI time from baseline to follow-up (OR = 0.24, 95% CI [-1.25, 1.74]).

Our study did not show a considerable difference between the two groups. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CAD.