Background: Carotid free-floating thrombus (CFFT), a thrombus in the carotid artery that is not firmly attached to the vessel wall, posing a high risk of embolic stroke. There is a major debate over the management of this condition. In this meta-analysis and systematic review, the efficacy of anticoagulant versus antiplatelet was compared to determine which approach leads to better outcomes and to solve the debate. Method: A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to identify studies published up to January 2025 that provided data on outcomes associated with anticoagulant or antiplatelet therapy in patients with CFFT. Key outcomes assessed included the incidence of recurrent stroke, thrombus resolution, and bleeding complications. The PRISMA flow diagram records search and selection are outlined in Figure 1.: Result: The analysis included three studies. No significant difference was found between anticoagulant and antiplatelet therapy in terms of complete resolution (RR=1.11 (95%CI: 0.75–1.65); P=0.59), partial resolution (RR=0.61 (95%CI: 0.09–4.18); P=0.62), thrombus worsening (RR=0.62 (95%CI:0.29–1.30); P=0.20), recurrent stroke (RR=1.55 (95% CI:0.29–8.32); P=0.61), and bleeding complication (RR=1.35 (95%CI:0.61–2.99); P=0.45). (Figure.2): Conclusion: Both anticoagulant and antiplatelet therapy showed similar efficacy and safety profiles in terms of treating CFFT, indicating that both are viable in the treatment of CFFT. However, future randomized clinical trials with larger sample are needed to confirm this conclusion.
Kelani et al. (Thu,) studied this question.