Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents

Arch Surg. 2009 Jul;144(7):685-90. doi: 10.1001/archsurg.2009.111.


Hypothesis: We hypothesize that the 2 antithrombotic treatment regimens, systemic heparin sodium vs antiplatelet agents, are equivalent for the treatment of blunt cerebrovascular injuries (BCVIs) to prevent devastating injury-related strokes.

Design: Retrospective review of a prospective database.

Setting: Level I trauma center.

Patients: Patients with BCVIs from January 1, 1997, to January 1, 2007.

Main outcome measures: Incidence of cerebrovascular accident (CVA), stratified by treatment.

Results: During the study period, 422 BCVIs were identified in 301 patients (64.8% men; mean [SEM] age, 37.0 [0.8] years; mean [SEM] injury severity score, 27.0 [0.9]). A total of 22 patients presented with neurologic ischemia, and 5 patients sustained CVAs after embolization and/or stenting of an injury. Treatment was initiated for 282 asymptomatic BCVIs (heparin, 192; aspirin, 67; aspirin and/or clopidogrel, 23); 1 patient had a CVA (0.5%). Of 107 patients with untreated, asymptomatic BCVIs, 23 (21.5%) had a CVA. For untreated patients sustaining BCVI-related CVAs, the mean (SEM) time to diagnosis was 58 (10) hours. For those who did not exhibit symptoms within 2 hours of injury, mean time to diagnosis of CVA was 75 (11) hours. Injury healing rates (heparin, 39%; aspirin, 43%; aspirin/clopidogrel, 46%) and injury progression rates (12%; 10%; 15%) were equivalent between therapeutic regimens.

Conclusions: With an overall CVA risk of 21% and a documented latent period, comprehensive screening, early diagnosis, and institution of antithrombotic therapy for BCVI are clearly warranted. The type of treatment, heparin vs antiplatelet agents, does not appear to affect either stroke risk or injury healing rates.

MeSH terms

  • Adult
  • Brain Injuries / complications
  • Brain Injuries / drug therapy*
  • Cerebrovascular Disorders / drug therapy*
  • Contraindications
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Head Injuries, Closed / drug therapy*
  • Heparin / administration & dosage*
  • Humans
  • Injury Severity Score
  • Male
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Retrospective Studies
  • Stroke / epidemiology
  • Stroke / prevention & control*
  • Thrombelastography
  • Treatment Outcome


  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Heparin