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Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?

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Abstract

Antiplatelet agents and vitamin K antagonists (VKA) are usually used in the treatment of cervical (carotid or vertebral) artery dissections (CADs); however, data about the use of direct oral anticoagulants (DOACs) in these conditions are very limited. DOACs have proven to be effective in stroke reduction in non-valvular atrial fibrillation and, when possible, they are preferred to warfarin because of their better safety profile. 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 patients 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 recanalization without stroke recurrence or bleedings, even in patients with intracranial vertebral artery involvement. DOACs could be an alternative in young patients with CADs and their use could be considered in intracranial artery dissections too.

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Authors and Affiliations

  1. Department of Neurology Unit, Azienda USL-IRCCS, Reggio Emilia, RE, Italy

    Giovanni Malferrari & Franco Valzania

  2. Department of Neuroscience, St. Agostino Estense Hospital, University of Modena and Reggio Emilia, Modena, Italy

    Domenico Laterza

  3. Department of Urgency and Emergency – Stroke Unit, S. Spirito Hospital, Pescara, PE, Italy

    Daniela Monaco

  4. Department of Medicine, Maggiore Hospital, Bologna, BO, Italy

    Mauro Silingardi & Attilia Maria Pizzini

Authors
  1. Giovanni Malferrari
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  2. Domenico Laterza
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  3. Franco Valzania
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  4. Daniela Monaco
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  5. Mauro Silingardi
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  6. Attilia Maria Pizzini
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Correspondence to Domenico Laterza.

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Malferrari, G., Laterza, D., Valzania, F. et al. Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option?. Neurol Sci 40, 1591–1596 (2019). https://doi.org/10.1007/s10072-019-03882-8

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  • DOI: https://doi.org/10.1007/s10072-019-03882-8

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