OBJECTIVE: To present the results of the nonrandomized arm of the Cervical 
Artery Dissection in Stroke Study (CADISS-NR) trial, comparing anticoagulation 
and antiplatelets for prevention of recurrent stroke after carotid and vertebral 
dissection, and perform a meta-analysis of these results with previously 
published studies comparing the 2 therapeutic strategies.
METHODS: A total of 88 patients from 22 centers with extracranial carotid and 
vertebral dissection were recruited within 1 month of symptom onset. The primary 
endpoint was recurrent stroke at 3 months. A systematic review was performed, 
and results of published studies included in a meta-analysis with the CADISS-NR 
results.
RESULTS: In CADISS-NR, one patient in each group had recurrent ischemic stroke 
(antiplatelet 1/59 [1.69% ], anticoagulation 1/28 [3.57%]). At the primary 
endpoint of 3 months, 3 (5.08%) antiplatelet patients had recurrent TIA, 
compared with none in the anticoagulation group. For meta-analysis, there were 
data from 40 nonrandomized studies including 1,636 patients. There was no 
significant difference between the 2 treatments in recurrent stroke risk 
(antiplatelet 13/499 [2.6%], anticoagulant 20/1,137 [1.8%], odds ratio [OR] 
1.49) or risk of death (antiplatelet 5/499 [1.00%], anticoagulant 9/1,137 
[0.80%], OR 1.27).
CONCLUSION: There is no evidence for superiority of anticoagulation or 
antiplatelet therapy in prevention of stoke after carotid and vertebral artery 
dissection; however, all data are from nonrandomized studies and randomized 
studies are required. The nonrandomized CADISS data show a lower rate of 
recurrent stroke than reported in some previous studies.
CLINICAL TRIAL REGISTRATION INFORMATION: www.dissection.co.uk, ISRNCTN44555237.