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Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series

BACKGROUND: The use of antithrombotic therapy (anticoagulants and/or antiplatelets) in the setting of traumatic cervical arterial dissection (CAD) for the prevention of stroke remains controversial. This issue is further complicated by the frequent co-existence of intracranial hemorrhage (ICH) and o...

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Autores principales: Hinson, Holly E, Stallmeyer, M JB, Furuno, Jon P, Yarbrough, Karen L, Cole, John W
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012017/
https://www.ncbi.nlm.nih.gov/pubmed/21144045
http://dx.doi.org/10.1186/1752-2897-4-13
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author Hinson, Holly E
Stallmeyer, M JB
Furuno, Jon P
Yarbrough, Karen L
Cole, John W
author_facet Hinson, Holly E
Stallmeyer, M JB
Furuno, Jon P
Yarbrough, Karen L
Cole, John W
author_sort Hinson, Holly E
collection PubMed
description BACKGROUND: The use of antithrombotic therapy (anticoagulants and/or antiplatelets) in the setting of traumatic cervical arterial dissection (CAD) for the prevention of stroke remains controversial. This issue is further complicated by the frequent co-existence of intracranial hemorrhage (ICH) and other intracranial injuries, and also the wide variability in treatment due to a lack of evidence-based guidance. To address these controversies, a registry in a major Level I trauma center was created. The purpose of this investigation was to compare the safety of antithrombotic therapy in post-traumatic CAD. Analysis from the first year is presented. METHODS: All cervical dissections from the year 2005 were identified in patients at least 18 years of age by diagnosis code from radiology and trauma databases. Presence of arterial injury and grade, and other intracranial disease or injury such as stroke was diagnosed by a trauma radiologist and adjudicated by a neuroradiologist. RESULTS: Fifty-five patients with cervical artery dissection were identified. Fourteen patients presented with a total of 20 acute, post-traumatic intracranial hemorrhages (ICH). Seven of the 14 patients with ICH were treated with antithrombotic therapy, and none extended their intracranial hemorrhages. Of the 41 patients without pre-existing ICH, 28 were treated with antithrombotic therapy and only one developed an interval hematoma. Among all 55 cases, two patients developed an acute ischemic stroke in the territory of the dissected artery after admission; both patients were in the untreated group. CONCLUSION: In so far as antithrombotic therapy may offer benefit in preventing early ischemic stroke following cervical artery dissection, these data suggest withholding antiplatelet or other antithrombotics following trauma may not be warranted, even in the setting of intracranial hemorrhage. From a safety perspective, this registry-based case series indicates antithrombotic management of arterial injury did not contribute to development or progression of ICH, even in patients with pre-existing ICH. This data suggest that instituting early antithrombotic therapy presents a low risk of ICH or hemorrhage extension among traumatic cervical dissection patients.
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spelling pubmed-30120172010-12-30 Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series Hinson, Holly E Stallmeyer, M JB Furuno, Jon P Yarbrough, Karen L Cole, John W J Trauma Manag Outcomes Research BACKGROUND: The use of antithrombotic therapy (anticoagulants and/or antiplatelets) in the setting of traumatic cervical arterial dissection (CAD) for the prevention of stroke remains controversial. This issue is further complicated by the frequent co-existence of intracranial hemorrhage (ICH) and other intracranial injuries, and also the wide variability in treatment due to a lack of evidence-based guidance. To address these controversies, a registry in a major Level I trauma center was created. The purpose of this investigation was to compare the safety of antithrombotic therapy in post-traumatic CAD. Analysis from the first year is presented. METHODS: All cervical dissections from the year 2005 were identified in patients at least 18 years of age by diagnosis code from radiology and trauma databases. Presence of arterial injury and grade, and other intracranial disease or injury such as stroke was diagnosed by a trauma radiologist and adjudicated by a neuroradiologist. RESULTS: Fifty-five patients with cervical artery dissection were identified. Fourteen patients presented with a total of 20 acute, post-traumatic intracranial hemorrhages (ICH). Seven of the 14 patients with ICH were treated with antithrombotic therapy, and none extended their intracranial hemorrhages. Of the 41 patients without pre-existing ICH, 28 were treated with antithrombotic therapy and only one developed an interval hematoma. Among all 55 cases, two patients developed an acute ischemic stroke in the territory of the dissected artery after admission; both patients were in the untreated group. CONCLUSION: In so far as antithrombotic therapy may offer benefit in preventing early ischemic stroke following cervical artery dissection, these data suggest withholding antiplatelet or other antithrombotics following trauma may not be warranted, even in the setting of intracranial hemorrhage. From a safety perspective, this registry-based case series indicates antithrombotic management of arterial injury did not contribute to development or progression of ICH, even in patients with pre-existing ICH. This data suggest that instituting early antithrombotic therapy presents a low risk of ICH or hemorrhage extension among traumatic cervical dissection patients. BioMed Central 2010-12-13 /pmc/articles/PMC3012017/ /pubmed/21144045 http://dx.doi.org/10.1186/1752-2897-4-13 Text en Copyright ©2010 Hinson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Hinson, Holly E
Stallmeyer, M JB
Furuno, Jon P
Yarbrough, Karen L
Cole, John W
Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title_full Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title_fullStr Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title_full_unstemmed Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title_short Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
title_sort antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012017/
https://www.ncbi.nlm.nih.gov/pubmed/21144045
http://dx.doi.org/10.1186/1752-2897-4-13
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