PMID- 34144568
OWN - NLM
STAT- MEDLINE
DCOM- 20210923
LR  - 20230825
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 91
IP  - 1
DP  - 2021 Jul 1
TI  - Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary 
      trauma center, systematic review, and meta-analysis.
PG  - e1-e12
LID - 10.1097/TA.0000000000003194 [doi]
AB  - BACKGROUND: Blunt cerebrovascular injuries (BCVIs) may occur following trauma and 
      lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk; 
      however, the optimal agent has yet to be determined in this population. The aim 
      of this study was to compare the risk-benefit profile of antiplatelet (AP) versus 
      anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic 
      complications in BCVI patients. METHODS: We performed a retrospective review of 
      BCVI patients at our tertiary care Trauma hospital from 2010 to 2015, and a 
      systematic review and meta-analysis of the literature. The OVID Medline, Embase, 
      Web of Science, and Cochrane Library databases were searched from inception to 
      September 16, 2019. References of included publications were searched manually 
      for other relevant articles. The search was limited to articles in humans, in 
      patients 18 years or older, and in English. Studies that reported 
      treatment-stratified clinical outcomes following AP or AC treatment in BCVI 
      patients were included. Exclusion criteria included case reports, case series 
      with n < 5, review articles, conference abstracts, animal studies, and 
      non-peer-reviewed publications. Data were extracted from each study independently 
      by two reviewers, including study design, country of origin, sex and age of 
      patients, Injury Severity Score, Biffl grade, type of treatment, ischemic stroke 
      rate, and hemorrhage rate. Pooled estimates using odds ratio (OR) were combined 
      using a random-effects model using a Mantel-Hanzel weighting. The main outcome of 
      interest was rate of ischemic stroke due to BCVI, and the secondary outcome was 
      hemorrhage rate based on AC or AP treatment. RESULTS: In total, there were 2044 
      BCVI patients, as reported in the 22 studies in combination with our 
      institutional data. The stroke rate was not significantly different between the 
      two treatment groups (OR, 1.27; 95% confidence interval, 0.40-3.99); however, the 
      hemorrhage rate was decreased in AP versus AC treated groups (OR, 0.38; 95% 
      confidence interval, 0.15-1.00). CONCLUSION: Based on this meta-analysis, both AC 
      and AP seem similarly effective in preventing ischemic stroke, but AP is better 
      tolerated in the trauma population. This suggests that AP therapy may be 
      preferred, but this should be further assessed with prospective randomized 
      trials. LEVEL OF EVIDENCE: Review article, level II.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Ku, Jerry C
AU  - Ku JC
AD  - From the Division of Neurosurgery (J.C.K., S.M.P., F.M., S.T., C.R.P., V.X.D.Y., 
      L.d.C.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto; 
      Health Sciences North, Division of Neurosurgery (S.M.P.), Northern Ontario School 
      of Medicine, Sudbury, ON; Biomedical Engineering, Faculty of Engineering 
      (F.A.Z.), Department of Anatomy and Cell Science, Rady Faculty of Health Sciences 
      (F.A.Z.), and Centre on Aging (F.A.Z.), University of Manitoba, Winnipeg, MA, 
      Canada; Division of Anaesthesia, Department of Medicine (F.A.Z.), Addenbrooke's 
      Hospital, University of Cambridge, Cambridge, United Kingdom; and Sunnybrook 
      Health Sciences Centre, Department of Medical Imaging (M.M.), Sunnybrook Health 
      Sciences Centre, Department of Surgery (A.N.), and Department of Medical Imaging, 
      Sunnybrook Health Sciences Centre (L.d.C.), University of Toronto, Toronto, ON, 
      Canada.
FAU - Priola, Stefano M
AU  - Priola SM
FAU - Mathieu, Francois
AU  - Mathieu F
FAU - Taslimi, Shervin
AU  - Taslimi S
FAU - Pasarikovski, Christopher R
AU  - Pasarikovski CR
FAU - Zeiler, Frederick A
AU  - Zeiler FA
FAU - Machnowska, Matylda
AU  - Machnowska M
FAU - Nathens, Avery
AU  - Nathens A
FAU - Yang, Victor X D
AU  - Yang VXD
FAU - da Costa, Leodante
AU  - da Costa L
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cerebrovascular Trauma/complications/diagnosis/*drug therapy
MH  - Female
MH  - Head Injuries, Closed/complications/diagnosis/*drug therapy
MH  - Hemorrhage/chemically induced/*epidemiology
MH  - Humans
MH  - Injury Severity Score
MH  - Ischemic Stroke/*epidemiology/etiology/prevention & control
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Trauma Centers/statistics & numerical data
MH  - Treatment Outcome
EDAT- 2021/06/19 06:00
MHDA- 2021/09/24 06:00
CRDT- 2021/06/18 20:31
PHST- 2021/06/18 20:31 [entrez]
PHST- 2021/06/19 06:00 [pubmed]
PHST- 2021/09/24 06:00 [medline]
AID - 01586154-202107000-00036 [pii]
AID - 10.1097/TA.0000000000003194 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2021 Jul 1;91(1):e1-e12. doi: 
      10.1097/TA.0000000000003194.