Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury.

Background: Early antithrombotic therapy (AT) is the mainstay of treatment in the management of blunt cerebrovascular injury (BCVI). In spite of this, optimal timing of initiation of AT in patients with BCVI in the presence of concomitant traumatic brain injury (TBI) or solid organ injury (SOI) remains controversial. The purpose of this study was to evaluate the impact of early initiation of AT on outcomes in patients with BCVI and TBI and/or SOI. Methods: Patients with BCVI and concomitant TBI and/or SOI over 6 years were identified. Aspirin and/or clopidogrel or low-intensity heparin infusion (AT) was instituted in all patients immediately upon diagnosis of BCVI. Cessation of AT, worsening TBI, need for delayed operative intervention, ischemic stroke, and mortality were reviewed and compared. Worsening of TBI or delayed operative intervention for SOI were compared to patients without BCVI treated at the same institution over the study period. Results: 119 patients (74 TBI, 26 SOI, and 19 combined) were identified. 71% were treated with heparin infusion (goal aPTT 45-60 seconds) and 29% received antiplatelet therapy alone. Compared to patients without BCVI, there was no difference in worsening of TBI (9% vs 10% with no BCVI, p=0.75) or need for delayed operative intervention for SOI (7% vs 5% with no BCVI, p=0.61). No patients required cessation of AT. A total of 11 (9%) of the patients experienced a BCVI-related stroke. Conclusions: Initiation of early AT for patients with BCVI and concomitant TBI or SOI does not increase risk of worsening TBI or SOI above baseline. Close monitoring is required, but our results suggest that appropriate antiplatelet or heparin therapy should not be withheld in patients with BCVI and concomitant TBI or SOI. In fact, prompt treatment with either antiplatelet or heparin therapy remains the mainstay for prevention of stroke-related morbidity and mortality in these patients. Level of Evidence: Therapuetic/Care Management, Level III (C) 2016 Lippincott Williams & Wilkins, Inc.

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