Choice of Antiplatelet vs. Anticoagulant for Blunt Cerebrovascular Injury

Blunt cerebrovascular injury (BCVI) defines a relatively common finding in trauma-injured patients, seen in roughly 2.4% of trauma patients. Unrecognized and untreated complications of BCVI can include stroke and neurological deficits. Increased use of CT angiography has led to a greater incidence of BCVI in traumatic brain injury and polytrauma patients, prompting a greater understanding of treatment options to mitigate morbidity. Antiplatelet medications, including aspirin and P2Y12 inhibitors (e.g., clopidogrel), as well as warfarin, dual oral anticoagulants (DOAC, e.g., dabigatran, rivaroxaban, apixaban, and edoxaban) provide a wide variety of medical treatment options. This article serves as a review of current evidence from 2015 to 2025 regarding best practices involving antiplatelet and anticoagulation use in the treatment of BCVI.