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Tue May 5 23:41:04 BST 2009

There is not much role for observing unfortunately. The next symptom is catastrophic stroke and you are too late. If you observe you take the risk of it, which could be ok when the anticoagulation has higher risk. The neurological symptoms are not gradual, usually all or nothing...Zsolt Balogh

>>> julie miller <jamiller444 at yahoo.com> 6/05/2009 8:26 am >>>
Khumar,

We would anticoagulate him if there were no contraindication.
We have discussed this topic several times, including at our journal club. The data is conflicting.
Anecdotally we've had a few patients (mostly  young females)
who arrived intact have catastrophic stokes from blunt carotid injury. 

I think without a head injury, the risk/benefit ratio would favor anticoagulation.

Julie Miller
Royal Melbourne Hospital

________________________________
From: khumar huseynova <khumarhuse at yahoo.ca>
To: trauma-list at trauma.org 
Sent: Wednesday, May 6, 2009 6:53:22 AM
Subject: Blunt CCA injury ina stable YOUNG pt

24M w post-blunt trauma. Stable. Has intimal dissection of common carotid art w 50% lumen obstruction. Asymptomatic from injury currently. No other injuries. What would you do-anticoagulate w LOW-dose heparin; give ASA only; stent; or operate? 
KH 

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Blunt CCA injury ina stable YOUNG pt