Stroke Prevention in Blunt Cerebrovascular Injury: Role of Aspirin 81 mg

Sina Asaadi; Christopher B Khoury; Julia Han; Martin G Rosenthal; Allen G Murga; Justin Dye; Kaushik Mukherjee; Miguel Lopez-Gonzalez; Ian Kershisnik; Marie L Crandall; Maryam B Tabrizi

doi:10.1016/j.avsg.2023.12.082

Stroke Prevention in Blunt Cerebrovascular Injury: Role of Aspirin 81 mg

Ann Vasc Surg. 2024 Mar 14:105:1-9. doi: 10.1016/j.avsg.2023.12.082. Online ahead of print.

Affiliations

¹ Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA.
² Division of Vascular Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA.
³ Department of Neurological Surgery, Loma Linda University, Loma Linda, CA.
⁴ Department of Surgery, University of Florida Health-Jacksonville, Jacksonville, FL.
⁵ Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA. Electronic address: MTabrizi@llu.edu.

PMID: 38492727
DOI: 10.1016/j.avsg.2023.12.082

Abstract

Background: The stroke rate in blunt cerebrovascular injury (BCVI) varies from 25% without treatment to less than 8% with antithrombotic therapy. There is no consensus on the optimal management to prevent stroke BCVI. We investigated the efficacy and safety of oral Aspirin (ASA) 81 mg to prevent BCVI-related stroke compared to historically reported stroke rates with ASA 325 mg and heparin.

Methods: A single-center retrospective study included adult trauma patients who received oral ASA 81 mg for BCVI management between 2013 and 2022. Medical records were reviewed for demographic and injury characteristics, imaging findings, treatment-related complications, and outcomes.

Results: Eighty-four patients treated with ASA 81 mg for BCVI were identified. The mean age was 41.50 years, and 61.9% were male. The mean Injury Severity Score and Glasgow Coma Scale were 19.82 and 12.12, respectively. A total of 101 vessel injuries were identified, including vertebral artery injuries in 56.4% and carotid artery injuries in 44.6%. Traumatic brain injury was found in 42.9%, and 16.7% of patients had a solid organ injur. Biffl grade I (52.4%) injury was the most common, followed by grade II (37.6%) and grade III (4.9%). ASA 81 mg was started in the first 24 hours in 67.9% of patients, including 20 patients with traumatic brain injury and 8 with solid organ injuries. BCVI-related stroke occurred in 3 (3.5%) patients with Biffl grade II (n = 2) and III (n = 1). ASA-related complications were not identified in any patient. The mean length of stay in the hospital was 10.94 days, and 8 patients died during hospitalization due to complications of polytrauma. Follow-up with computed tomography angiography was performed in 8 (9.5%) patients, which showed improvement in 5 and a stable lesion in 3 at a mean time of 58 days after discharge.

Conclusions: In the absence of clear guidelines regarding appropriate medication, BCVI management should be individualized case-by-case through a multidisciplinary approach. ASA 81 mg is a viable option for BCVI-related stroke prevention compared to the reported stroke rates (2%-8%) with commonly used antithrombotics like heparin and ASA 325 mg. Future prospective studies are needed to provide insight into the safety and efficacy of the current commonly used agent in managing BCVI.