T. W. Wolff1, C. Spalding1, E. Esposito2, J. Simpson3, J. A. Dunn7, L. Zier7, S. Burruss5, L. E. Jacobson6, J. Williams6, J. Nahmias12, A. Grigorian12, L. Harmon7, A. Gergen7, M. Chatoor11, R. Rattan11, A. J. Young8, J. L. Pascual8, J. Murry9, A. W. Ong10, A. Muller10, R. S. Sandhu15, R. Appelbaum15, N. Bugaev14, A. Tatar14, K. Zreik13, L. Hustad13, S. Deas4, J. A. Kufera2, D. M. Stein2, T. M. Scalea2, M. H. Lauerman2 1Grant Medical Center,Division Of Trauma, Surgical Critical Care, And Acute Care Surgery,Columbus, OH, USA 2University Of Maryland,Division Of Critical Care And Trauma,Baltimore, MD, USA 3Greenville Hospital System,Greenville, SC, USA 4UCHealth Medical Center of the Rockies,Loveland, CO, USA 5Loma Linda University School Of Medicine,Loma LInda, CA, USA 6Indiana University School Of Medicine,Indianapolis, IN, USA 7University Of Colorado Denver,Aurora, CO, USA 8University Of Pennsylvania,Philadelphia, PA, USA 9University of Texas Health Science Center,Tyler, TX, USA 10Reading Hospital,Reading, PA, USA 11University Of Miami,Miami, FL, USA 12University Of California – Irvine,Orange, CA, USA 13Sanford Health,Sioux Falls, SD, USA 14Tufts Medical Center,Boston, MA, USA 15Lehigh Valley Health Network,Allentown, PA, USA
Introduction:
Treatment for blunt cerebrovascular injury (BCVI) includes antiplatelets (AP) or anticoagulation (AC) and is without standardized guidelines. We hypothesized that treatment of grade I vertebral BCVI with aspirin alone would be associated with similar stroke rate compared to additional AP or AC therapies.
Methods:
This was a sub-analysis of an EAST multicenter, prospective, observational trial including 16 centers. Only grade I vertebral BCVI receiving medical therapy were included. Aspirin monotherapy (ASA) was defined as aspirin alone without alteration during the hospitalization. Non-aspirin therapy (non-ASA) was any other pharmaceutical therapy separate from or in combination with aspirin, or a change from aspirin to another agent. Bivariate and survival analyses were used to evaluate the stroke rate between ASA and non-ASA.
Results:
We analyzed 140 grade I vertebral BCVI (116 ASA, 24 non-ASA). Mean neck abbreviated injury scale score was slightly higher for non-ASA compared with ASA (2.67 vs. 2.12, p=0.01) as was injury severity score (22.00 vs. 16.00, p=0.14). Time to therapy was shorter in non-ASA compared with ASA (15 vs. 27 hours, p=0.03). Treatment complications were similar for non-ASA compared with ASA (4.2% vs. 1.7%, p=0.43). One patient in each group had a BCVI-related stroke, without difference in stroke rate for non-ASA compared with ASA (4.2% vs. 0.9%, p=0.31). The ASA patient with a stroke had aspirin started after the stroke, while the non-ASA patient had medical therapy started prior to the stroke. Tarone-Ware survival analysis did not show a difference in stroke between non-ASA and ASA (p=0.69).
Conclusion:
Stroke risk is low in patients with grade I vertebral BCVI, regardless of therapy. Stroke and complications using ASA are equivalent to other AP and AC strategies even though it was started later.