Document Detail

Blunt vascular injuries of the head and neck: is heparinization necessary?
MedLine Citation:
PMID:  9867039     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined. METHODS: The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. RESULTS: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge. CONCLUSION: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.
S R Eachempati; S N Vaslef; M W Sebastian; R L Reed
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  45     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-20     Completed Date:  1999-01-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  997-1004     Citation Subset:  AIM; IM    
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
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MeSH Terms
Anticoagulants / therapeutic use*
Blood Vessels / injuries*
Craniocerebral Trauma / drug therapy*,  physiopathology
Emergency Treatment* / methods
Glasgow Coma Scale
Heparin / therapeutic use*
Injury Severity Score
Medical Records
Middle Aged
Neck Injuries / drug therapy*,  physiopathology
Retrospective Studies
Wounds, Nonpenetrating / drug therapy*
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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