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Published on: February 28, 2012
Aspirin versus anticoagulation for stroke prophylaxis in blunt cerebrovascular injury: a propensity-matched
Robert H Bonow1,2, Cordelie E Witt1,3, Mahmud Mossa-Basha1,4
11Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle.
Insights
Aspirin may be more effective than therapeutic anticoagulation for preventing stroke in patients with blunt cerebrovascular injury (BCVI). This study found a higher stroke risk with anticoagulation, suggesting a need for further research into optimal BCVI treatment strategies.
Area of Science:
- Neurology
- Trauma Surgery
- Vascular Surgery
Background:
- Blunt cerebrovascular injury (BCVI) is a significant concern in trauma patients.
- Optimal medical management for BCVI to prevent stroke remains under investigation.
Purpose of the Study:
- To compare the risk of delayed stroke in patients with BCVI treated with therapeutic anticoagulation versus aspirin.
Main Methods:
- Retrospective cohort study of 677 BCVI patients over 10 years.
- Exact logistic regression and propensity score matching were used to analyze treatment outcomes.
- Patients with stroke on arrival or within 24 hours were excluded.
Main Results:
- Anticoagulation was associated with a higher likelihood of stroke (OR 3.01) compared to aspirin.
- Propensity-matched analysis showed a 15.0% higher probability of stroke with anticoagulation.
- Stroke occurred in 3.8% of aspirin patients versus 11.7% of anticoagulation patients.
Conclusions:
- Therapeutic anticoagulation may be less effective than aspirin for stroke prevention in BCVI.
- Further prospective research is needed to confirm these findings and guide treatment.
Objective:
The goal of this study was to compare the odds of stroke 24 hours or more after hospital arrival among patients with blunt cerebrovascular injury (BCVI) who were treated with therapeutic anticoagulation versus aspirin.
Methods:
The authors conducted a retrospective cohort study at a regional level I trauma center including all patients with BCVI who were treated over a span of 10 years. Individuals with stroke on arrival or within the first 24 hours were excluded, as were those receiving alternative antithrombotic drugs or procedural treatment. Exact logistic regression was used to examine the association between treatment and stroke, adjusting for injury grade. To account for the possibility of residual confounding, propensity scores for the likelihood of receiving anticoagulation were determined and used to match patients from each treatment group; the difference in the probability of stroke between the two groups was then calculated.
Results:
A total of 677 patients with BCVI receiving aspirin or anticoagulation were identified. A total of 3.8% (n = 23) of 600 patients treated with aspirin sustained a stroke, compared to 11.7% (n = 9) of 77 receiving anticoagulation. After adjusting for injury grade with exact regression, anticoagulation was associated with higher likelihood of stroke (OR 3.01, 95% CI 1.00-8.21). In the propensity-matched analysis, patients who received anticoagulation had a 15.0% (95% CI 3.7%-26.3%) higher probability of sustaining a stroke compared to those receiving aspirin.
Conclusions:
Therapeutic anticoagulation may be inferior to aspirin for stroke prevention in BCVI. Prospective research is warranted to definitively compare these treatment strategies.
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