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Asaadi S, Khoury CB, Han J, Rosenthal MG, Murga AG, Dye J, Mukherjee K, Lopez-Gonzalez M, Kershisnik I, Crandall ML, Tabrizi MB. Stroke Prevention in Blunt Cerebrovascular Injury: Role of Aspirin 81 mg. Ann Vasc Surg 2024; 105:1-9. [PMID: 38492727 DOI: 10.1016/j.avsg.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND The stroke rate in blunt cerebrovascular injury (BCVI) varies from 25% without treatment to less than 8% with antithrombotic therapy. There is no consensus on the optimal management to prevent stroke BCVI. We investigated the efficacy and safety of oral Aspirin (ASA) 81 mg to prevent BCVI-related stroke compared to historically reported stroke rates with ASA 325 mg and heparin. METHODS A single-center retrospective study included adult trauma patients who received oral ASA 81 mg for BCVI management between 2013 and 2022. Medical records were reviewed for demographic and injury characteristics, imaging findings, treatment-related complications, and outcomes. RESULTS Eighty-four patients treated with ASA 81 mg for BCVI were identified. The mean age was 41.50 years, and 61.9% were male. The mean Injury Severity Score and Glasgow Coma Scale were 19.82 and 12.12, respectively. A total of 101 vessel injuries were identified, including vertebral artery injuries in 56.4% and carotid artery injuries in 44.6%. Traumatic brain injury was found in 42.9%, and 16.7% of patients had a solid organ injur. Biffl grade I (52.4%) injury was the most common, followed by grade II (37.6%) and grade III (4.9%). ASA 81 mg was started in the first 24 hours in 67.9% of patients, including 20 patients with traumatic brain injury and 8 with solid organ injuries. BCVI-related stroke occurred in 3 (3.5%) patients with Biffl grade II (n = 2) and III (n = 1). ASA-related complications were not identified in any patient. The mean length of stay in the hospital was 10.94 days, and 8 patients died during hospitalization due to complications of polytrauma. Follow-up with computed tomography angiography was performed in 8 (9.5%) patients, which showed improvement in 5 and a stable lesion in 3 at a mean time of 58 days after discharge. CONCLUSIONS In the absence of clear guidelines regarding appropriate medication, BCVI management should be individualized case-by-case through a multidisciplinary approach. ASA 81 mg is a viable option for BCVI-related stroke prevention compared to the reported stroke rates (2%-8%) with commonly used antithrombotics like heparin and ASA 325 mg. Future prospective studies are needed to provide insight into the safety and efficacy of the current commonly used agent in managing BCVI.
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Affiliation(s)
- Sina Asaadi
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Christopher B Khoury
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Julia Han
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Martin G Rosenthal
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Allen G Murga
- Division of Vascular Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Justin Dye
- Department of Neurological Surgery, Loma Linda University, Loma Linda, CA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | | | - Ian Kershisnik
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA
| | - Marie L Crandall
- Department of Surgery, University of Florida Health-Jacksonville, Jacksonville, FL
| | - Maryam B Tabrizi
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA.
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Perez NP, Stapleton SM, Tabrizi MB, Watkins MT, Lillemoe KD, Kelleher CM, Chang DC. The impact of race on choice of location for elective surgical care in New York city. Am J Surg 2020; 219:557-562. [PMID: 32007235 DOI: 10.1016/j.amjsurg.2020.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/07/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.
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Affiliation(s)
- Numa P Perez
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA.
| | - Sahael M Stapleton
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Maryam B Tabrizi
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael T Watkins
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Keith D Lillemoe
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Cassandra M Kelleher
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
| | - David C Chang
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
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Peponis T, Kasotakis G, Yu J, Alouidor R, Burkott B, Maung AA, Johnson DC, Saillant N, Walden H, Salim A, Bryant E, Dorfman JD, Klein EN, Elefant R, Tabrizi MB, Bugaev N, Arabian SS, Velmahos GC. Selective Nonoperative Management of Abdominal Gunshot Wounds from Heresy to Adoption: A Multicenter Study of the Research Consortium of New England Centers for Trauma (ReCoNECT). J Am Coll Surg 2017; 224:1036-1045. [DOI: 10.1016/j.jamcollsurg.2016.12.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/30/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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