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

• Published in: Neurological sciences Vol. 40; no. 8; pp. 1591 - 1596
• Main Authors: Malferrari, Giovanni, Laterza, Domenico, Valzania, Franco, Monaco, Daniela, Silingardi, Mauro, Pizzini, Attilia Maria
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2019; Springer Nature B.V
• Subjects: Adult; Angiography; Antagonists; Anticoagulants; Antiplatelet therapy; Carotid Artery, Internal, Dissection - complications; Carotid Artery, Internal, Dissection - drug therapy; Dissection; Factor Xa Inhibitors - therapeutic use; Female; Fibrillation; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Patients; Psychiatry; Rivaroxaban - therapeutic use; Stroke; Stroke - prevention & control; Vertebrae; Vertebral Artery Dissection - complications; Vertebral Artery Dissection - drug therapy; Vitamin K; Warfarin; Rivaroxaban; Stroke; Neurosonology; Transcranial color Doppler; Cervical and cervico-cerebral artery dissections; DOACs
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-019-03882-8

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.