Is Anticoagulation Necessary for Asymptomatic Unilateral Vertebral Artery Injury?

VAI occurs commonly in association with cervical spine trauma. Yet, there is a dearth of literature investigating whether unilateral, asymptomatic VAI can be safely treated with observation or requires pharmacologic treatment to reduce ischemic neurological complications. On the basis of the available literature, consideration should be given to treating asymptomatic unilateral VAI with observation because of the lack of quality evidence demonstrating the superiority of pharmacologic treatment and the risk of bleeding complications associated with pharmacologic interventions.