Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate
Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate
复制标题
DOI：
10.1001/archsurg.139.5.540
复制
发表时间：
2004-05-01
影响因子：
--
通讯作者：
Burch, JM
中科院分区：
文献类型：
--
作者：
Cothren, CC;Moore, EE;Burch, JM
Hypothesis: Aggressive screening, early angiographic diagnosis, and prompt anticoagulation for blunt carotid artery injuries (CAIs) improves neurologic outcome.Design: From January 1, 1996, through December 3 1, 2002, there were 13 280 blunt trauma admissions to our level I center, of which 643 under-went screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without con-traindications underwent anticoagulation immediately for documented lesions.Setting: A state-designated, level I urban trauma centerPatients: Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.Intervention: Early angiographic diagnosis and prompt anticoagulation.Main Outcome Measures: Diagnosis, stroke rate, and complications stratified by method of intervention.Results: A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean SD age of 34 +/- 1.3 years and a mean +/- SD Injury Severity Score of 29 +/-1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, low-molecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angio-graphic diagnosis and those receiving a carotid coil or stent without anticoagulation.Conclusions: Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.
