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Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST
William Kelley1, Khaled Zreik2, Anna Gergen3
1Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Insights
Treatment for blunt cerebrovascular injury (BCVI) in patients with traumatic brain injury (TBI) appears safe and reduces stroke risk. Early BCVI treatment may prevent strokes without increasing bleeding complications.
Area of Science:
- Neurology
- Trauma Surgery
- Vascular Surgery
Background:
- Blunt cerebrovascular injury (BCVI) concurrent with traumatic brain injury (TBI) increases risks of ischemic stroke and bleeding.
- Investigating the safety and survival benefits of BCVI treatment (antithrombotic/anticoagulant therapy) in this patient population.
- Hypothesis: BCVI treatment reduces stroke incidence and delays stroke onset in TBI patients without increasing bleeding complications.
Purpose of the Study:
- To evaluate the safety and efficacy of treating BCVI in patients with concurrent TBI.
- To determine if BCVI treatment impacts stroke rates and survival.
- To assess the association between BCVI treatment and bleeding complications in TBI patients.
Main Methods:
- Retrospective analysis of 488 BCVI patients with concurrent TBI (head AIS >0).
- Kaplan-Meier analysis compared stroke-free survival between treated and untreated groups.
- Logistic regression identified predictors of stroke, controlling for confounding variables.
Main Results:
- 347 patients (71.1%) received BCVI treatment, initiated at a median of 31 hours post-admission.
- BCVI treatment significantly lowered stroke rates (4.9% vs. 24.1%, P < .001) and improved stroke-free survival (P < .001).
- No increase in bleeding complications or TBI worsening was observed; treatment predicted fewer strokes.
Conclusions:
- Patients with BCVI and TBI who did not receive treatment had a higher early stroke rate.
- BCVI treatment within 2-3 days may be safe for TBI patients with moderate head injury (mean AIS 2.6).
- Further prospective trials are necessary to confirm findings and establish optimal treatment timing.
Background:
Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications.
Methods:
Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial. A Kaplan-Meier analysis compared stroke survival in patients who received BCVI treatment to those who did not. Logistic regression was used to evaluate for confounding variables.
Results:
Of 488 patients, 347 (71.1%) received BCVI treatment and 141 (28.9%) did not. BCVI treatment was given at a median of 31 h post-admission. BCVI treatment was associated with lower stroke rate (4.9% vs 24.1%, P < .001 and longer stroke-free survival (P < .001), but also less severe systemic injury. Logistic regression identified motor GCS and BCVI treatment as the only predictors of stroke. No patients experienced worsening TBI because of treatment.
Discussion:
Patients with BCVI and TBI who did not receive BCVI treatment had an increased rate of stroke early in their hospital stay, though this effect may be confounded by worse motor deficits and systemic injuries. BCVI treatment within 2-3 days of admission may be safe for patients with mean head AIS of 2.6. Future prospective trials are needed to confirm these findings and determine optimal timing of BCVI treatment in TBI patients with BCVI.
