Aspirin or Anticoagulation to Prevent Stroke in Carotid Dissection?

Spontaneous extracranial internal carotid artery dissection is an uncommon cause of acute ischemic stroke. Treatment is aimed at prevention of subsequent ischemic stroke, and the choice of treatment is largely empirical and based almost exclusively on case series. Although anticoagulation with heparin followed by warfarin is the most common treatment, no prospective randomized trials have compared this regimen to antiplatelet therapy.

In a retrospective analysis of 298 consecutive adult patients who presented with spontaneous extracranial internal carotid artery dissection to two hospitals in Switzerland during an 18-year period, investigators compared rates of subsequent ischemic events and hemorrhagic complications between patients treated…