Table 4

Results and conclusions of included studies for stroke rates

Study
(authors)
Patients (n)*Outcome measure(s)TreatmentConclusions
None†AntiplateletAnticoagulantStent/coilSurgery
ASA‡PlavixComboWarfarinHeparin
Cothren et al22105Stroke5/270/170/565/5Early diagnosis and prompt anticoagulation reduce stroke and disability.
Snow et al1341Stroke1/103/31Treatment with antithrombotic does not seem to change neurologic outcome.
Wei et al1124Stroke1/111/120/1Unable to make conclusions about treatment-related risk reduction.
Miller et al657
48
CAI - stroke
VAI - stroke
7/11
2/4
1/12
1/13
2/34
0/31
Treat with anticoagulation therapy unless contraindicated, otherwise treat with antiplatelet.
Stein et al19141Stroke8/312/702/33Any treatment results in lower stroke rate but many patients have contraindications to treatment.
Cothren et al2138Stroke0/40/20/134/19Carotid stent has an unacceptable occlusion rate with limited acute benefit.
Malhotra et al2026Stroke0/101/70/50/4Interventional procedures for higher grade injuries may explain low stroke rate.
Wagenaar et al10790Stroke38/1428/648Vast majority of injuries do not resolve despite treatment.
Callcut et al1673Stroke16/281/221/22Early treatment of BCVI with concomitant neurologic injury is safe (article combined ASA/heparin results).
Burlew et al14195Stroke1/1722/23Stroke can almost be universally avoided with antithrombotic therapy. Stenting reserved for symptomatic BCVI.
DiCocco et al17202Stroke2/1222/80Endovascular therapy has equivalent outcomes to medical management but was used more often in higher grade injuries.
Miller et al2363CAI - stroke
VAI - stroke
0/0
1/3

0/24

0/8
1/9
0/8
Heparin should be first line unless contraindicated; antiplatelet should then be considered.
Biffl et al220§Stroke1/55/15Optimal treatment not clear but anticoagulation seems to improve outcomes.
Cothren9389¶Stroke23/1070/670/231/192Anticoagulation and antithrombotic are comparative treatments for asymptomatic BCVI.
Biffl et al7117*Stroke3/331/84Randomized control required to determine optimal treatment.
Lebl et al1541*Stroke2/182/120/10/12/9Consider treatment once contraindications resolve.
Hwang et al1867Stroke0/201/160/10/21/70/21/100/31/6 warfarin/ASA and 0/1 Clexane; no firm conclusion about treatment.
Catapano et al563**Stroke0/102/471/6
  • *Subgroup of asymptomatic BCVI.

  • †No treatment often due to contraindications to coagulation or planned withdrawal of care.

  • ‡81 mg or 325 mg.

  • §Subgroup analysis in patients without significant confounding injuries.

  • ¶All BCVIs, not number of patients.

  • **Only patients who survived to discharge and no stroke before diagnosis (asymptomatic).

  • ASA, acetylsalicylic acid; BCVI, blunt cerebrovascular injury; CAI, carotid artery injury; VAI, vertebral artery injury.