The role of hypercoagulability in ischemic stroke associated with blunt cerebrovascular injury

Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing coagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via coagulation profile, including thromboelastography (TEG) and coagulation studies, on ischemic stroke incidence following BCVI.

This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 h of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI. Receiver operating curves (ROC) with area under the curve (AUC) were constructed for incident strokes.

38 patients met inclusion criteria with 22 (57.9 %) being male with a median age of 51 (20.25). The most common mechanism of injury was motor vehicle collision occurring in 17 (44.7 %) patients. Seven (18.4 %) suffered ischemic strokes in the distribution of BCVI. The stroke group were found to have significantly decreased R value (3.7 [2.45-4.15] vs. 4.3 [3.75-4.8], p = 0.040), fibrinogen (197.9 (62.7) vs. 282.1 (103.9), p = 0.049), and aPTT (23.5 [22.8-26.4] vs. 27.8 [26.2-35.0], p = 0.039). On ROC analysis, R value (AUC = 0.75), fibrinogen (AUC = 0.75), and PTT (AUC = 0.76) had high discriminatory value for incident stroke while the highest Biffl grade did not (AUC = 0.48).

In this cohort of patients with blunt cerebrovascular injury, those with evidence of hypercoagulation experienced an increased incidence of BCVI-related ischemic stroke in the distribution of injury. While larger studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier initiation of anti-thrombotic prophylaxis.