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Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study

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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.

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Acknowledgments

We thank Kristin Kraus, MSc, for her editorial assistance.

Funding

Funding for this project was received through the Primary Children’s Hospital Foundation Grant in the amount of $14,750. REDcap use and management was funded by Center for Clinical and Translational Sciences grant support (8UL1TR000105 (formerly UL1RR025764) NCATS/NIH).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Vijay M. Ravindra, Robert J. Bollo, Al-Wala Awad, Yekaterina Birkas, John R. Kestle & Ramesh Grandhi

  2. Division of Pediatric Neurosurgery, Primary Children’s Hospital, Salt Lake City, UT, USA

    Vijay M. Ravindra, Robert J. Bollo, Al-Wala Awad, Yekaterina Birkas, John R. Kestle & Ramesh Grandhi

  3. Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA

    Michael C. Dewan, Stephen Gannon, Chevis Shannon & Robert P. Naftel

  4. Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA

    Michael C. Dewan, Stephen Gannon, Chevis Shannon & Robert P. Naftel

  5. Department of Clinical Neurosciences, Division of Pediatric Neurosurgery, University of Calgary, Calgary, Alberta, Canada

    Jay K. Riva-Cambrin

  6. Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA

    Daniel Tonetti

  7. Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA

    S. Hassan Akbari & David Limbrick

  8. Division of Pediatric Neurosurgery, St. Louis Children’s Hospital, St. Louis, MO, USA

    S. Hassan Akbari & David Limbrick

  9. Department of Neurosurgery, Indiana University, Bloomington, IN, USA

    Andrew Jea

  10. Division of Pediatric Neurosurgery, Riley Children’s Hospital, Indianapolis, IN, USA

    Andrew Jea

Authors
  1. Vijay M. Ravindra
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  2. Robert J. Bollo
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  3. Michael C. Dewan
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  4. Jay K. Riva-Cambrin
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  5. Daniel Tonetti
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  6. Al-Wala Awad
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  7. S. Hassan Akbari
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  8. Stephen Gannon
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  9. Chevis Shannon
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  10. Yekaterina Birkas
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  11. David Limbrick
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  12. Andrew Jea
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  13. Robert P. Naftel
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  14. John R. Kestle
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  15. Ramesh Grandhi
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Corresponding author

Correspondence to Ramesh Grandhi.

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Conflict of interest

Dr. Limbrick reports research funding for an unrelated project through Medtronic and educational funds and research funding through Storz. Dr. Grandhi is a consultant for Medtronic Neurovascular, Cerenovus, and BALT Neurovascular. The other authors have no disclosures.

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Ravindra, V.M., Bollo, R.J., Dewan, M.C. et al. Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study. Childs Nerv Syst 37, 47–54 (2021). https://doi.org/10.1007/s00381-020-04672-w

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  • DOI: https://doi.org/10.1007/s00381-020-04672-w

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