Antithrombotic therapy in blunt cerebrovascular injury—Do we need more information?

Introduction: Blunt cerebrovascular injury is an infrequent, but potentially devastating cause of morbidity following blunt trauma. Most recommendations regarding treatment of blunt cerebrovascular injury advocate the use of antithrombotic medications, based on biased evidence. We aim to describe the experience with blunt cerebrovascular injury at a major trauma center and to validate the benefits of antithrombotic treatment in blunt cerebrovascular injury. Methods: A retrospective cohort study of all adult (>16 years) patients diagnosed with blunt cerebrovascular injury at a major trauma center over a 6-year period. Outcomes were assessed and analyzed to determine neurological sequelae related specifically to blunt cerebrovascular injury. Results: Blunt cerebrovascular injury had an incidence of 0.57% in our patient population and 97 patients were initially included for analysis. In subsequent analysis, 39 patients (40.2%) were deemed nonassessable and were excluded, leaving 44 treated and 14 untreated patients. There were no differences between the groups in neurological change or outcome. Three treated patients suffered hemorrhagic complications. Conclusions: While there is an association between treatment of blunt cerebrovascular injury with antithrombotics and improved outcomes, selection bias influences these results. Accounting for this bias, the association is no longer demonstrable and treatment does not appear to alter the outcome.