Antiplatelet therapy: an alternative to heparin for blunt carotid injury.
BACKGROUND
Blunt carotid injuries (BCIs) are uncommon. Most single-center studies are small and highlight the use of anticoagulation for treatment. In a retrospective review, we identified 22 patients who presented with BCI and assessed neurologic and survival outcomes on the basis of injury grade and treatment with anticoagulation or antiplatelet therapy.


METHODS
Patient demographics were identified using the trauma registry at a single Level I trauma center. Chart reviews assessed neurologic function, modalities used for diagnosis, and treatment. Neurologic outcomes were graded good (minimal to no deficit), fair (moderate deficit needing some assistance), poor (requiring institutionalization), and dead.


RESULTS
Twenty-two adult trauma patients were diagnosed with BCI, for an incidence of 0.45% in the 8-year study period. All BCI patients underwent head computed tomography and four-vessel cerebral arteriography. Eight patients were not anticoagulated, five because of intracranial injuries, two who had surgical CCA repairs, and one with an aortic injury. Full anticoagulation with heparin was attempted in seven patients, with four major bleeding complications requiring cessation of heparin and blood transfusions. Seven patients received antiplatelet therapy. No difference in neurologic outcome was observed between those receiving anticoagulation and those receiving antiplatelet therapy. Bleeding complications from full anticoagulation were higher than with antiplatelet agents (p = 0.05).


CONCLUSIONS
Contrary to previous reports, we did not observe improved outcomes with full anticoagulation compared with antiplatelet therapy. Anticoagulation was associated with increased extracranial bleeding complications. The risks and possible benefits, as well as timing, of anticoagulation or antiplatelet therapy for BCI should be carefully weighed by the major care providers of the patient with multiple injuries.
Wahl
Wendy L
WL
Division of Trauma Burn and Emergency Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0033, USA. wlwahl@med.umich.edu
Brandt
Mary-Margaret
MM
Thompson
B Gregory
BG
Taheri
Paul A
PA
Greenfield
Lazar J
LJ
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D020212:Carotid Artery Injuries / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin