Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate

C Clay Cothren, Ernest E Moore, Walter L Biffl, David J Ciesla, Charles E Ray, Jeffrey L Johnson, John B Moore, Jon M Burch
Archives of Surgery 2004, 139 (5): 540-5; discussion 545-6

HYPOTHESIS: Aggressive screening, early angiographic diagnosis, and prompt anticoagulation for blunt carotid artery injuries (CAIs) improves neurologic outcome.

DESIGN: From January 1, 1996, through December 31, 2002, there were 13 280 blunt trauma admissions to our level I center, of which 643 underwent screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without contraindications underwent anticoagulation immediately for documented lesions.

SETTING: A state-designated, level I urban trauma center.

PATIENTS: Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.

INTERVENTION: Early angiographic diagnosis and prompt anticoagulation.

MAIN OUTCOME MEASURES: Diagnosis, stroke rate, and complications stratified by method of intervention.

RESULTS: A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean +/- SD age of 34 +/- 1.3 years and a mean +/- SD Injury Severity Score of 29 +/- 1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, low-molecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angiographic diagnosis and those receiving a carotid coil or stent without anticoagulation.

CONCLUSIONS: Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.

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