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Updated: Nov 1, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review,
Jerry C Ku1, Stefano M Priola, Francois Mathieu
1From the Division of Neurosurgery (J.C.K., S.M.P., F.M., S.T., C.R.P., V.X.D.Y., L.d.C.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto; Health Sciences North, Division of Neurosurgery (S.M.P.), Northern Ontario School of Medicine, Sudbury, ON; Biomedical Engineering, Faculty of Engineering (F.A.Z.), Department of Anatomy and Cell Science, Rady Faculty of Health Sciences (F.A.Z.), and Centre on Aging (F.A.Z.), University of Manitoba, Winnipeg, MA, Canada; Division of Anaesthesia, Department of Medicine (F.A.Z.), Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; and Sunnybrook Health Sciences Centre, Department of Medical Imaging (M.M.), Sunnybrook Health Sciences Centre, Department of Surgery (A.N.), and Department of Medical Imaging, Sunnybrook Health Sciences Centre (L.d.C.), University of Toronto, Toronto, ON, Canada.
Insights
Antiplatelet (AP) therapy is as effective as anticoagulant (AC) therapy in preventing ischemic stroke in blunt cerebrovascular injury (BCVI) patients. AP therapy showed a lower hemorrhage rate, suggesting it may be preferred in trauma populations.
Area of Science:
- Trauma Surgery
- Neurology
- Vascular Surgery
Background:
- Blunt cerebrovascular injuries (BCVIs) pose a risk of ischemic stroke if left untreated.
- Antithrombotic therapy is used to mitigate this risk, but the optimal agent remains unclear.
- This study compares antiplatelet (AP) and anticoagulant (AC) therapies in BCVI patients.
Purpose of the Study:
- To compare the risk-benefit profiles of AP versus AC therapy in BCVI patients.
- To evaluate rates of ischemic stroke and hemorrhagic complications associated with each treatment.
- To determine the optimal antithrombotic agent for BCVI management.
Main Methods:
- Retrospective review of BCVI patients (2010-2015) and a systematic review/meta-analysis of literature.
- Searched OVID Medline, Embase, Web of Science, and Cochrane Library databases.
- Included studies reporting treatment-stratified outcomes; excluded case reports and non-peer-reviewed publications.
Main Results:
- Analyzed 2044 BCVI patients across 22 studies.
- No significant difference in ischemic stroke rates between AP and AC groups (OR, 1.27).
- Hemorrhage rates were significantly lower in the AP group compared to the AC group (OR, 0.38).
Conclusions:
- Both AC and AP therapies appear similarly effective in preventing ischemic stroke in BCVI patients.
- AP therapy demonstrated a better safety profile with reduced hemorrhage rates.
- AP therapy may be preferred for BCVI patients, warranting further investigation in randomized trials.
Background:
Blunt cerebrovascular injuries (BCVIs) may occur following trauma and lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk; however, the optimal agent has yet to be determined in this population. The aim of this study was to compare the risk-benefit profile of antiplatelet (AP) versus anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic complications in BCVI patients.
Methods:
We performed a retrospective review of BCVI patients at our tertiary care Trauma hospital from 2010 to 2015, and a systematic review and meta-analysis of the literature. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to September 16, 2019. References of included publications were searched manually for other relevant articles. The search was limited to articles in humans, in patients 18 years or older, and in English. Studies that reported treatment-stratified clinical outcomes following AP or AC treatment in BCVI patients were included. Exclusion criteria included case reports, case series with n < 5, review articles, conference abstracts, animal studies, and non-peer-reviewed publications. Data were extracted from each study independently by two reviewers, including study design, country of origin, sex and age of patients, Injury Severity Score, Biffl grade, type of treatment, ischemic stroke rate, and hemorrhage rate. Pooled estimates using odds ratio (OR) were combined using a random-effects model using a Mantel-Hanzel weighting. The main outcome of interest was rate of ischemic stroke due to BCVI, and the secondary outcome was hemorrhage rate based on AC or AP treatment.
Results:
In total, there were 2044 BCVI patients, as reported in the 22 studies in combination with our institutional data. The stroke rate was not significantly different between the two treatment groups (OR, 1.27; 95% confidence interval, 0.40-3.99); however, the hemorrhage rate was decreased in AP versus AC treated groups (OR, 0.38; 95% confidence interval, 0.15-1.00).
Conclusion:
Based on this meta-analysis, both AC and AP seem similarly effective in preventing ischemic stroke, but AP is better tolerated in the trauma population. This suggests that AP therapy may be preferred, but this should be further assessed with prospective randomized trials.
Level Of Evidence:
Review article, level II.
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