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

  • Giovanni Malferrari
  • Domenico LaterzaEmail author
  • Franco Valzania
  • Daniela Monaco
  • Mauro Silingardi
  • Attilia Maria Pizzini
Original Article

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.

Keywords

Cervical and cervico-cerebral artery dissections Stroke Transcranial color Doppler Neurosonology DOACs Rivaroxaban 

Notes

Compliance with ethical standards

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  • Giovanni Malferrari
    • 1
  • Domenico Laterza
    • 2
    Email author
  • Franco Valzania
    • 1
  • Daniela Monaco
    • 3
  • Mauro Silingardi
    • 4
  • Attilia Maria Pizzini
    • 4
  1. 1.Department of Neurology UnitAzienda USL-IRCCSReggio EmiliaItaly
  2. 2.Department of Neuroscience, St. Agostino Estense HospitalUniversity of Modena and Reggio EmiliaModenaItaly
  3. 3.Department of Urgency and Emergency – Stroke UnitS. Spirito HospitalPescaraItaly
  4. 4.Department of MedicineMaggiore HospitalBolognaItaly

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