Table 4.
Results and conclusions of included studies for stroke rates
| Study (authors) |
Patients (n)* | Outcome measure(s) | Treatment | Conclusions | |||||||
| None† | Antiplatelet | Anticoagulant | Stent/coil | Surgery | |||||||
| ASA‡ | Plavix | Combo | Warfarin | Heparin | |||||||
| Cothren et al22 | 105 | Stroke | 5/27 | 0/17 | – | 0/56 | 5/5 | – | Early diagnosis and prompt anticoagulation reduce stroke and disability. | ||
| Snow et al13 | 41 | Stroke | 1/10 | 3/31 | – | – | Treatment with antithrombotic does not seem to change neurologic outcome. | ||||
| Wei et al11 | 24 | Stroke | 1/11 | 1/12 | 0/1 | – | Unable to make conclusions about treatment-related risk reduction. | ||||
| Miller et al6 | 57 48 |
CAI - stroke VAI - stroke |
7/11 2/4 |
1/12 1/13 |
2/34 0/31 |
– | Treat with anticoagulation therapy unless contraindicated, otherwise treat with antiplatelet. | ||||
| Stein et al19 | 141 | Stroke | 8/31 | 2/70 | 2/33 | – | Any treatment results in lower stroke rate but many patients have contraindications to treatment. | ||||
| Cothren et al21 | 38 | Stroke | 0/4 | 0/2 | – | 0/13 | 4/19 | – | Carotid stent has an unacceptable occlusion rate with limited acute benefit. | ||
| Malhotra et al20 | 26 | Stroke | 0/10 | 1/7 | 0/5 | 0/4 | – | Interventional procedures for higher grade injuries may explain low stroke rate. | |||
| Wagenaar et al10 | 790 | Stroke | 38/142 | 8/648 | – | Vast majority of injuries do not resolve despite treatment. | |||||
| Callcut et al16 | 73 | Stroke | 16/28 | 1/22 | – | – | – | 1/22 | – | – | Early treatment of BCVI with concomitant neurologic injury is safe (article combined ASA/heparin results). |
| Burlew et al14 | 195 | Stroke | – | 1/172 | 2/23 | – | Stroke can almost be universally avoided with antithrombotic therapy. Stenting reserved for symptomatic BCVI. | ||||
| DiCocco et al17 | 202 | Stroke | – | 2/122 | 2/80 | – | Endovascular therapy has equivalent outcomes to medical management but was used more often in higher grade injuries. | ||||
| Miller et al23 | 63 | CAI - stroke VAI - stroke |
0/0 1/3 |
– 0/24 |
– 0/8 |
1/9 0/8 |
– | Heparin should be first line unless contraindicated; antiplatelet should then be considered. | |||
| Biffl et al2 | 20§ | Stroke | 1/5 | – | – | – | – | 5/15 | – | – | Optimal treatment not clear but anticoagulation seems to improve outcomes. |
| Cothren9 | 389¶ | Stroke | 23/107 | 0/67 | – | 0/23 | – | 1/192 | – | – | Anticoagulation and antithrombotic are comparative treatments for asymptomatic BCVI. |
| Biffl et al7 | 117* | Stroke | – | 3/33 | – | – | – | 1/84 | – | – | Randomized control required to determine optimal treatment. |
| Lebl et al15 | 41* | Stroke | 2/18 | 2/12 | – | 0/1 | 0/1 | 2/9 | – | – | Consider treatment once contraindications resolve. |
| Hwang et al18 | 67 | Stroke | 0/20 | 1/16 | 0/1 | 0/2 | 1/7 | 0/2 | 1/10 | 0/3 | 1/6 warfarin/ASA and 0/1 Clexane; no firm conclusion about treatment. |
| Catapano et al5 | 63** | Stroke | 0/10 | 2/47 | – | – | – | – | 1/6 | – | |
*Subgroup of asymptomatic BCVI.
†No treatment often due to contraindications to coagulation or planned withdrawal of care.
‡81 mg or 325 mg.
§Subgroup analysis in patients without significant confounding injuries.
¶All BCVIs, not number of patients.
**Only patients who survived to discharge and no stroke before diagnosis (asymptomatic).
ASA, acetylsalicylic acid; BCVI, blunt cerebrovascular injury; CAI, carotid artery injury; VAI, vertebral artery injury.