Evidence map›Paper›PMID 40828475›Full record

ArticleNeurosurgical review2025

Antithrombotic therapy delays due to neurosurgical interventions after traumatic vertebral artery injuries increases stroke risk.

Zixin Yi, Jessica Vankawala, Manisha Koneru, Joshua Santucci, Charles Morse, Joseph Ifrach, Zein Al-Atrache, Nicole M Fox, Anna Goldenberg-Sandau, Jane Khalife and 4 more

Abstract read
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Article in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Zixin YiCooper Medical School of Rowan University, Camden, NJ, USA.
Jessica VankawalaCooper Medical School of Rowan University, Camden, NJ, USA.
Manisha KoneruCooper Medical School of Rowan University, Camden, NJ, USA.
Joshua SantucciCooper Medical School of Rowan University, Camden, NJ, USA.
Charles MorseCooper Medical School of Rowan University, Camden, NJ, USA.
Joseph IfrachCooper Medical School of Rowan University, Camden, NJ, USA.
Zein Al-AtracheCooper Medical School of Rowan University, Camden, NJ, USA.
Nicole M FoxCooper Medical School of Rowan University, Camden, NJ, USA.
Anna Goldenberg-SandauCooper Medical School of Rowan University, Camden, NJ, USA.
Jane KhalifeCooper Medical School of Rowan University, Camden, NJ, USA.
Daniel A TonettiCooper Medical School of Rowan University, Camden, NJ, USA.
Tudor G JovinCooper Medical School of Rowan University, Camden, NJ, USA.
Hamza A ShaikhCooper Medical School of Rowan University, Camden, NJ, USA.
Corey M MossopCooper Medical School of Rowan University, Camden, NJ, USA. mossop-corey@cooperhealth.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTraumatic vertebral artery injury (TVAI) poses a risk for ischemic stroke, often requiring prompt antithrombotic therapy. However, when concomitant neurosurgical intervention is necessary, concerns regarding perioperative bleeding frequently lead to delays in antithrombotic initiation. This study evaluates the impact of delayed antithrombotic therapy on stroke risk in TVAI patients undergoing neurosurgical interventions.

methodsA retrospective review was conducted of a TVAI registry over 7 years (2016-2023) at a level 1 trauma center for patients who were treated with antithrombotics for stroke prevention. Baseline demographics, vertebral artery injury characteristics, concomitant injury characteristics, acute management and outcomes were compared between surgical and non-surgical cohorts. Statistical analyses included Student's t-test, Chi-square tests, relative risk (RR), and attributable risk (AR).

resultsAmong the 121 patients, 44 (36.4%) underwent neurosurgical procedures. The surgical cohort experienced an average 2-day delay in antithrombotic initiation (p < 0.001). The incidence of stroke in the neurosurgical intervention group was 20.5%, which was significantly higher than 5.19% in the control group (p = 0.016), with an associated RR of 3.94 and excess AR of 15.3%. No significant differences in baseline antithrombotic use, injury severity, or mortality were observed between cohorts.

conclusionDelayed antithrombotic initiation in TVAI patients undergoing neurosurgical intervention is associated with a nearly fourfold increased risk of stroke. Future multi-center studies should explore neurosurgical strategies allowing safer early antithrombotic initiation in this patient population. CLINICAL TRIAL NUMBER: not applicable.

Indexed as

Fibrinolytic AgentsNeurosurgical ProceduresStrokeVertebral ArteryAdultAgedFemaleHumansMaleMiddle AgedRegistriesRetrospective StudiesRisk FactorsTime-to-TreatmentFibrinolytic AgentsAntithrombotic therapyCerebrovascular traumaNeurosurgeryStroke riskVertebral artery dissection

Identifiers

PMID40828475

What Socratic holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.