Survivors don't need more predictions of failure to recover. THEY NEED 100% RECOVERY PROTOCOLS. GET THERE! Useless crapola.
Predictors and Outcomes of Neurological Deterioration in Intracerebral Hemorrhage: Results from the TICH-2 Randomized Controlled Trial
Translational Stroke Research (2020)
Abstract
Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70–6.70; p < 0.001). Tranexamic acid reduced the risk of early (aOR 0.79, 0.63–0.99; p = 0.041) but not late neurological deterioration (aOR 0.76, 0.52–1.11; p = 0.15). Larger hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL:https://www.isrctn.com Unique identifier: ISRCTN93732214
Introduction
Neurological deterioration affects approximately one-third of patients with spontaneous intracerebral hemorrhage (ICH) and increases the risk of death and dependency [1,2,3]. Older age, prior use of anticoagulant, larger baseline hematoma, CT angiography spot sign, hematoma expansion, perihematomal edema, intraventricular hemorrhage, subarachnoid extension, hydrocephalus and leukoaraiosis were reported to increase the risk of neurological deterioration after ICH in previous studies [2,3,4,5,6]. Nevertheless, apart from hematoma expansion, reports of other neurological and systemic complications associated with neurological deterioration were not well documented [2,3,4,5,6].
Tranexamic acid is an antifibrinolytic agent that was effective in preventing death due to bleeding in major trauma and traumatic brain injury [7, 8]. In the Tranexamic acid in Intracerebral Hemorrhage-2 (TICH-2) trial, there was no significant difference in death and dependency at day 90 between ICH patients treated with tranexamic acid and placebo [9]. However, there was a significant reduction in the rates of hematoma expansion, early death and serious adverse events with tranexamic acid [9].
No comments:
Post a Comment