Table 4.
Current medical management for blunt traumatic vertebral artery injury
| Author and year | Title of study | Study design | Number of patients | Type of intervention | Outcome | Comments |
|---|---|---|---|---|---|---|
| Miller et al. 2001 [26] | Blunt cerebrovascular injuries: diagnosis and treatment. | Retrospective | 50 patients | 62% heparin, 26% aspirin, 8% no treatment, 4% low molecular weight dextran | Overall stroke rate 14%, heparin 0%, aspirin 9%. No treatment: 54% | 8% bleeding complications in heparin group |
| Biffl et al. 2002 [31] | Treatment-Related Outcomes From Blunt Cerebrovascular Injuries | Retrospective Trauma database | 171 patients combined carotid/vertebral |
29% of patients neurological deficit from TCVI 69% heparin 10% antiplatelets 18% none |
Heparin: 71% improved, 26% unchanged, 3% worsened Aspirin: 40% improved, 60% unchanged No treatment: 55% improved, 45% unchanged |
|
| Miller et al. 2002 [50] | Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes | Retrospective | 216 patients (43 with VAI) |
74% antiplatelets 18% heparin 8% none |
No evidence of stroke in either group | Heparin: 2 patients bleeding complications, antiplatelets: 1 patient GI bleed |
| Engelter et al. 2007 [52] | Antiplatelets versus anticoagulation in cervical artery dissection | Meta-analysis | 327 patients | Antiplatelets versus anticoagulation, dead or disabled outcome |
Dead or disabled: 23.7% antiplatelets 14.3%anticoagulants No significance |
|
| Cothen et al. 2009 [32] | Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents | Retrospective review of prospective database | 301, 282 of whom were treated medically |
Heparin, 192 aspirin, 67 aspirin and/or clopidogrel, 23 |
Injury healing rates (heparin, 39%; aspirin, 43%; aspirin/clopidogrel, 46%) and injury progression rates (12; 10; 15%) were equivalent between therapeutic regimens |
1 patient had a stroke (0.5%) |
| Stein et al. 2009 [24] | Blunt cerebrovascular injuries: does treatment always matter? | Retrospective | 147 patients TCVI |
22% endovascular 36% antiplatelets medications (10% anticoagulation 18% combination therapy antiplatelet/anticoagulation 30% no therapy primarily due to contraindications |
Stroke rate: 3.9% in treated patients 25.8% untreated patients |
TCVI traumatic cerebro vascular injury; GI gastroIntestinal; VAI vertebral artery injury; BCVI blunt cerebro vascular injury