Impact of systemic anticoagulation on traumatic cervical arterial repairs: An analysis of the PROspective Observational Vascular Injury Trial (PROOVIT) registry

Purpose: Systemic anticoagulation (SAC) is standard in elective arterial repairs but controversial in trauma due to bleeding risks, with unclear benefits in this population. This is the first study to investigate SAC's impact on cervical artery repairs. Methods: Using the PROOVIT database (2012–2023), we included all cervical arterial injuries (common carotid, internal/external carotid, or vertebral) who underwent surgical or endovascular repair, categorized by intraoperative SAC use. Primary outcomes included in-hospital complications; secondary outcomes were re-intervention, stroke, 24-h packed red blood cell (pRBC) transfusions, and length of stay (LOS). Results: One hundred forty patients met inclusion criteria. Median age was 34, and 79 % were male. 67.1 % sustained penetrating trauma, and 77 % had moderate to severe head trauma. SAC was used in 41 (29.3 %) patients. SAC use was more common in patients with higher Glasgow Coma Scale (GCS) scores and those undergoing primary surgical repair. Univariate analysis showed similar complication, re-intervention, and stroke rates. Multivariate analysis (adjusted for age, sex, mechanism, ISS, SBP <90, and GCS, see Figure) revealed SAC was associated with higher re-intervention rates (aOR = 3.9, 95 % CI: 1–13, p = 0.03) but not with overall complications (aOR = 2.4, p = 0.07), stroke (aOR = 1.6, p = 0.35), 24-h PRBC transfusions (B = −2.6, p = 0.27), or LOS (B = −4.5, p = 0.40). Conclusion: SAC during cervical arterial repair was associated with increased re-intervention rates without impacting complications, stroke, or LOS. Further research is needed to clarify its risk-benefit balance in trauma care.