The Role of Hypercoagulability in Bcvi-related Ischemic Stroke

Introduction: Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing hypercoagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via thromboelastography (TEG) on ischemic stroke incidence following BCVI.

Methods: This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 hours of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI and secondary outcomes included further characterization of admission.

Results: Forty-one patients met inclusion criteria. The average age was 52.2 and 24 (58.5%) were male. The most common mechanism of injury was motorized vehicle crash. Eight (19.5%) suffered ischemic strokes in the distribution of BCVI and 33 (80.5%) did not have a stroke. The stroke group experienced lower R (p = 0.029), higher clot index (p = 0.049), and lower PTT (p = 0.021). No significant differences were found in K, Alpha, MA, Ly30 and other coagulation studies (INR, platelet, fibrinogen) between stroke and non-stroke groups.

Conclusion : In this cohort of patients with blunt cerebrovascular injury, those admitted with TEG studies suggestive of hypercoagulation were associated with increased rate of BCVI-related ischemic stroke in the distribution of injury. While further studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier antithrombotic prophylaxis.