Vijay M Ravindra1,2, Robert J Bollo1,2, Michael C Dewan3,4, Jay K Riva-Cambrin5, Daniel Tonetti6, Al-Wala Awad1,2, S Hassan Akbari7,8, Stephen Gannon3,4, Chevis Shannon3,4, Yekaterina Birkas1,2, David Limbrick7,8, Andrew Jea9,10, Robert P Naftel3,4, John R Kestle1,2, Ramesh Grandhi11,12. 1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. 2. Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA. 3. Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA. 4. Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. 5. Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Calgary, Alberta, Canada. 6. Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA. 8. Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA. 9. Department of Neurosurgery, Indiana University, Bloomington, IN, USA. 10. Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, IN, USA. 11. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. neuropub@hsc.utah.edu. 12. Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA. neuropub@hsc.utah.edu.
Abstract
PURPOSE: Blunt cerebrovascular injury (BCVI) is uncommon in the pediatric population. Among the management options is medical management consisting of antithrombotic therapy with either antiplatelets or anticoagulation. There is no consensus on whether administration of antiplatelets or anticoagulation is more appropriate for BCVI in children < 10 years of age. Our goal was to compare radiographic and clinical outcomes based on medical treatment modality for BCVI in children < 10 years. METHODS: Clinical and radiographic data were collected retrospectively for children screened for BCVI with computed tomography angiography at 5 academic pediatric trauma centers. RESULTS: Among 651 patients evaluated with computed tomography angiography to screen for BCVI, 17 patients aged less than 10 years were diagnosed with BCVI (7 grade I, 5 grade II, 1 grade III, 4 grade IV) and received anticoagulation or antiplatelet therapy for 18 total injuries: 11 intracranial carotid artery, 4 extracranial carotid artery, and 3 extracranial vertebral artery injuries. Eleven patients were treated with antiplatelets (10 aspirin, 1 clopidogrel) and 6 with anticoagulation (4 unfractionated heparin, 2 low-molecular-weight heparin, 1 transitioned from the former to the latter). There were no complications secondary to treatment. One patient who received anticoagulation died as a result of the traumatic injuries. In aggregate, children treated with antiplatelet therapy demonstrated healing on 52% of follow-up imaging studies versus 25% in the anticoagulation cohort. CONCLUSION: There were no observed differences in the rate of hemorrhagic complications between anticoagulation and antiplatelet therapy for BCVI in children < 10 years, with a nonsignificantly better rate of healing on follow-up imaging in children who underwent antiplatelet therapy; however, the study cohort was small despite including patients from 5 hospitals.
PURPOSE: Blunt cerebrovascular injury (BCVI) is uncommon in the pediatric population. Among the management options is medical management consisting of antithrombotic therapy with either antiplatelets or anticoagulation. There is no consensus on whether administration of antiplatelets or anticoagulation is more appropriate for BCVI in children < 10 years of age. Our goal was to compare radiographic and clinical outcomes based on medical treatment modality for BCVI in children < 10 years. METHODS: Clinical and radiographic data were collected retrospectively for children screened for BCVI with computed tomography angiography at 5 academic pediatric trauma centers. RESULTS: Among 651 patients evaluated with computed tomography angiography to screen for BCVI, 17 patients aged less than 10 years were diagnosed with BCVI (7 grade I, 5 grade II, 1 grade III, 4 grade IV) and received anticoagulation or antiplatelet therapy for 18 total injuries: 11 intracranial carotid artery, 4 extracranial carotid artery, and 3 extracranial vertebral artery injuries. Eleven patients were treated with antiplatelets (10 aspirin, 1 clopidogrel) and 6 with anticoagulation (4 unfractionated heparin, 2 low-molecular-weight heparin, 1 transitioned from the former to the latter). There were no complications secondary to treatment. One patient who received anticoagulation died as a result of the traumatic injuries. In aggregate, children treated with antiplatelet therapy demonstrated healing on 52% of follow-up imaging studies versus 25% in the anticoagulation cohort. CONCLUSION: There were no observed differences in the rate of hemorrhagic complications between anticoagulation and antiplatelet therapy for BCVI in children < 10 years, with a nonsignificantly better rate of healing on follow-up imaging in children who underwent antiplatelet therapy; however, the study cohort was small despite including patients from 5 hospitals.
Authors: Tammy R Kopelman; Nicole E Berardoni; Patrick J O'Neill; Poya Hedayati; Sydney J Vail; Paola G Pieri; Iman Feiz-Erfan; Melissa A Pressman Journal: J Trauma Date: 2011-09
Authors: William J Bromberg; Bryan C Collier; Larry N Diebel; Kevin M Dwyer; Michelle R Holevar; David G Jacobs; Stanley J Kurek; Martin A Schreiber; Mark L Shapiro; Todd R Vogel Journal: J Trauma Date: 2010-02