Timing of Stroke After Blunt Cerebrovascular Dissection

July 12, 2018

Written by Clay Smith

Spoon Feed
Most strokes from blunt cerebrovascular injury (BCVI) occurred at a median time of 48 hours.  If other injuries allow it, the earlier antithrombotic therapy can be started, the better for preventing stroke.

Why does this matter?
Blunt cerebrovascular injury (BCVI) puts patients at risk for stroke.  But often these patients have other injuries that make antithrombotic therapy risky.  Newer research showed the risk of antithrombotic treatment was low risk in patients with solid organ injury.  What is the window before stroke happens in some patients with known traumatic dissection?

Balancing bleeding risk and stroke risk
This was a retrospective look at 10 years of trauma data.  They found 492 patients with BCVI-related stroke.  In 55%, the cause of death was attributed to the stroke.  Of the 302 who did not have stroke symptoms on admission or caused in IR, stroke occurred at a median 48 hours after admission; 60% within 72 hours; 85% within 7 days.  The largest number of strokes occurred between 13-24 hours.  Higher grade dissection was associated with increased stroke risk.  Only 22% were on antithrombotic therapy (defined as aspirin, clopidogrel, or heparin) at the time of the stroke.  Those untreated had other severe injuries deemed high risk for antithrombotic agents.  The take home is that early initiation of antithrombotic therapy may reduce subsequent stroke risk in patients with BCVI, but balancing this and the risk of other traumatic bleeding is tricky.

Source
TIME TO STROKE: A WESTERN TRAUMA ASSOCIATION MULTI-CENTER STUDY OF BLUNT CEREBROVASCULAR INJURIES.  J Trauma Acute Care Surg. 2018 May 25. doi: 10.1097/TA.0000000000001989. [Epub ahead of print]
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Reviewed by Thomas Davis

Another Spoonful
Go deep with this post on carotid artery dissection.