Journal article
Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study
The American surgeon, v 90(6), pp 1330-1337
01 Jun 2024
PMID: 38253324
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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Details
- Title
- Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study
- Creators
- William Kelley - University of Maryland, BaltimoreKhaled Zreik - Sanford HealthAnna Gergen - University of Colorado DenverJamie Williams - St Vincent HospitalLewis E. Jacobson - St Vincent HospitalJeffry Nahmias - University of California, IrvineAnthony Tatar - University of Massachusetts Chan Medical SchoolJason Murry - The University of Texas Health Science Center at TylerAreg Grigorian - University of California, IrvineAdrian Ong - Reading HospitalDeborah M. Stein - University of Maryland, BaltimoreThomas M. Scalea - University of Maryland, BaltimoreMargaret H. Lauerman - University of Maryland, Baltimore
- Publication Details
- The American surgeon, v 90(6), pp 1330-1337
- Publisher
- Sage
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001147220700001
- Scopus ID
- 2-s2.0-85183004745
- Other Identifier
- 991022020637804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Surgery