Antithrombotic Therapy in Blunt Cerebrovascular Injury: Associations With In-Hospital Mortality in a Contemporary Trauma Cohort

At our institution, aspirin (ASA) is the recommended treatment for blunt cerebrovascular injury (BCVI), and low molecular weight heparin (LMWH) is the preferred agent for venous thromboembolism prophylaxis. While both therapies are widely used and individually safe, evidence regarding their combined use in BCVI patients is limited. This study evaluated the safety of concurrent LMWH and ASA therapy in trauma patients with BCVI. Materials and Methods: We analyzed trauma admissions from 2021-2024 using the institutional trauma registry and an electronic medical record–based data warehouse at an adult Level I trauma center. Patients with and without BCVI were included. Univariate and bivariate analyses were performed using Student’s t-tests and chi-square tests, and multivariable logistic regression assessed associations between BCVI, medication use, and in-hospital mortality. Results: Among 4,306 included patients, 365 (8.5%) had BCVI. The mean age was 42 years, 36% were female, and 59% were White. After adjustment, BCVI was associated with increased odds of in-hospital mortality (OR 2.03, 95% CI 1.14-3.61, P = 0.015). Among patients with BCVI, treatment with LMWH alone, ASA alone, or combined LMWH and ASA was associated with significantly lower odds of in-hospital death (LMWH OR 0.09; ASA OR 0.29; combination OR 0.20; all P < 0.05). Discussion: Although BCVI occurred in fewer than one in twelve patients, it was associated with more than double the odds of mortality. Medical therapy, including combined antiplatelet and anticoagulant treatment, appears to be safe for use in BCVI patients.