(1546) Report of a Level 1 Trauma Center's Aspirin Practice for Treatment of Blunt Cerebrovascular Injury

Introduction: Blunt cerebrovascular injuries (BCVI) are rare but carry significant morbidity and mortality if left untreated. BCVI related stroke has been associated with stroke related mortality of up to 50%. The stroke risk after BCVI is highest during the first 3 days from injury. Current guidelines recommend antithrombotic treatment although do not provide definitive recommendations on the optimal pharmacologic agent, dose, or timing of intervention. This institution utilizes an aspirin (ASA) based approach for treatment of BCVI.

Methods: This is a retrospective cohort study that included adult patients from January 2015 through August 2022. Patients were evaluated if they were admitted with a traumatic mechanism and had presence of BCVI. Baseline characteristics were collected as well as data pertaining to ASA therapy, dose, and time to initiation. Incidence of in-hospital stroke was collected, time to stroke diagnosis, and incidence of major bleeding.

Results: 116 patients were included for analysis. Twenty eight patients were diagnosed with a grade I BCVI, 30 with a grade II, 10 with a grade III, and 48 with a grade IV BCVI. Most of the patients, 66.4% were initiated on ASA 325mg daily while 32.8% were initiated on ASA 81mg daily. 43.6% of patients who were initially started on 81mg were escalated to 325mg primarily due to the trauma team request. 71% of patients had ASA initiated within 2 days of BCVI diagnosis. 10.5% (n=12) of patients developed in-hospital stroke and all were not on ASA at that time or had history of home aspirin use. 8 patients developed stroke within the first 24hrs, one patient after day 2, and the remaining 3 were beyond 72 hrs. Of the 12 patients who developed stroke, 6 had a grade IV BCVI and 1 had a grade III. Zero patients experienced a major bleeding event.

Conclusions: Early initiation of aspirin therapy may prevent BCVI related stroke events with minimal occurrence of major bleeding events. The optimal dose of ASA remains unclear with variable doses used at this institution with zero incidence of stroke development while on therapy. Creation of a protocolized approach for treatment of BCVI should involve a multidisciplinary team.