Background: Ischemic stroke occurs following
trauma-related blunt cerebrovascular injury (BCVI) in up to 20% of cases.
Preventative treatment includes antiplatelets, anticoagulants, and/or
endovascular treatment (ET), but the optimal choice remains unclear. The
objective of this study was to compare the ischemic stroke rate between
these three treatments. Methods: Following PRISMA
guidelines, we queried the OVID Medline, Embase, Web of Science, and
Cochrane Library databases from September 2019 to inception to identify
studies reporting treatment-stratified outcomes in BCVI patients.
Meta-analysis was performed to compare outcomes between the treatment
groups, using odds ratios. Retrospective review of our institutional
experience with BCVI outcomes was performed and added to the meta-analysis.
Results: Analysis of seven comparative studies of
antiplatelets (n=334) versus anticoagulation (n=325) found no significant
difference in ischemic stroke rate (OR 1.27, 95%CI 0.40-3.99), but a
decrease in hemorrhagic complications (OR 0.38, 95%CI 0.15-1.00). Analysis
of seven comparative studies of antiplatelets/anticoagulants (n=805) versus
ET (n=235) also found no significant difference in stroke rate (OR 0.71,
95%CI 0.35-1.42). Conclusions: Antiplatelets and
anticoagulants were similarly effective in reducing ischemic stroke risk in
BCVI, but antiplatelets were better tolerated in this trauma population. The
addition of endovascular treatment did not further reduce stroke risk
compared to antiplatelets or anticoagulants alone.