Abstract Body: Introduction: Patients with traumatic vertebral artery injuries (TVAI) are at higher risk of ischemic stroke in the acute timeframe, which is mitigated by early antithrombotic treatment. However, TVAI patients commonly require neurosurgical interventions, such as spinal fixation for concomitant cervical spine injuries. The dilemma between risk of perioperative bleeding and benefit of stroke prevention guides practices for timing of antithrombotic therapy. This study aims to characterize the effect of delayed antithrombotic therapy due to neurosurgical interventions on TVAI patients.
Methods: A retrospective review was conducted of a TVAI registry over 7 years (2016-2023) at a level 1 trauma center for patients who were treated with antithrombotics for stroke prevention. Rate of stroke determined to be related to TVAI within 14 days of injury was summarized. The relative risk (RR), attributable risk (AR), and number needed to harm for patients undergoing neurosurgical interventions were compared to the control group.
Results: Among the 121 patients, 44 patients underwent neurosurgical intervention with mean 3.18 days (SD 2.16 days) before starting antithrombotics, which is a significantly longer duration than the 77 control cohort patients, whose mean time to antithrombotic start was 1.06 days (SD 1.15 days) (p < 0.0001). The incidence of stroke in the neurosurgical intervention group was 20.5%, which was significantly higher than 5.19% in the control group (p = 0.016). The RR was 3.94, and AR was 15.3%. For every 6.55 TVAI patients needing neurosurgical intervention for concomitant injuries, there will be one additional stroke event.
Conclusion: Delayed antithrombotic therapy for two additional days on average in TVAI patients for neurosurgical interventions was associated with approximately four times greater risk of stroke. Future studies are needed to assess the risks of earlier antithrombotic treatment in this TVAI subpopulation, in order to optimize the antithrombotic therapy window for maximal stroke prevention and minimal hemorrhage risk.