Beta blockers in traumatic brain injury: a systematic review and meta-analysis

Hart, Shannon; Lannon, Melissa; Chen, Andrew T.; Martyniuk, Amanda; Sharma, Sunjay; Engels, Paul T.

doi:10.1136/tsaco-2022-001051

Cited by 5 publications

(2 citation statements)

References 41 publications

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“…Our real-world data contrary to previous belief. Third, previous meta-analyses have shown that beta-blockers are effective in reducing mortality in patients with TBI [10]. Exposure to beta-blockers appears to improve functional outcome in patients with severe TBI in a matched case-control study [18].…”

Section: The Incidence Of Chf Was Higher In the Tbi Cohort Than In Th...mentioning

confidence: 94%

“…Since sympathetic system overactivity is believed to play a key role in the cardiac manifestations of TBI, several studies have investigated the protective role of beta-blockers in this setting [3]. A recent meta-analysis demonstrated that beta-blocker use after TBI reduces in-hospital mortality [10]. However, it is unclear whether the use of beta-blockers in patients with TBI reduces the risk of subsequent HF.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic brain injury and risk of heart failure and coronary heart disease: A nationwide population-based cohort study

Huang,

Yang,

Chang

2023

PLoS ONE

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Background This study examined the long-term risks of heart failure (HF) and coronary heart disease (CHD) following traumatic brain injury (TBI), focusing on gender differences. Methods Data from Taiwan’s National Health Insurance Research Database included 29,570 TBI patients and 118,280 matched controls based on propensity scores. Results The TBI cohort had higher incidences of CHD and HF (9.76 vs. 9.07 per 1000 person-years; 4.40 vs. 3.88 per 1000 person-years). Adjusted analyses showed a significantly higher risk of HF in the TBI group (adjusted hazard ratio = 1.08, 95% CI = 1.01–1.17, P = 0.031). The increased CHD risk in the TBI cohort became insignificant after adjustment. Subgroup analysis by gender revealed higher HF risk in men (aHR = 1.14, 95% CI = 1.03–1.25, P = 0.010) and higher CHD risk in women under 50 (aHR = 1.32, 95% CI = 1.15–1.52, P < 0.001). TBI patients without beta-blocker therapy may be at increased risk of HF. Conclusion Our results suggest that TBI increases the risk of HF and CHD in this nationwide cohort of Taiwanese citizens. Gender influences the risks differently, with men at higher HF risk and younger women at higher CHD risk. Beta-blockers have a neutral effect on HF and CHD risk.

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Section: The Incidence Of Chf Was Higher In the Tbi Cohort Than In Th...mentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Traumatic brain injury and risk of heart failure and coronary heart disease: A nationwide population-based cohort study

Huang,

Yang,

Chang

2023

PLoS ONE

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Early Intravenous Beta-Blockade with Esmolol in Adults with Severe Traumatic Brain Injury: A Phase 2a Intervention Design Study

Thomas,

Hayes,

White

et al. 2024

Neurocrit Care

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Background Targeted beta-blockade after severe traumatic brain injury may reduce secondary brain injury by attenuating the sympathoadrenal response. The potential role and optimal dosage for esmolol, a selective, short-acting, titratable beta-1 beta-blocker, as a safe, putative early therapy after major traumatic brain injury has not been assessed. Methods We conducted a single-center, open-label dose-finding study using an adaptive model-based design. Adults (18 years or older) with severe traumatic brain injury and intracranial pressure monitoring received esmolol within 24 h of injury to reduce their heart rate by 15% from baseline of the preceding 4 h while ensuring cerebral perfusion pressure was maintained above 60 mm Hg. In cohorts of three, the starting dosage and dosage increments were escalated according to a prespecified plan in the absence of dose-limiting toxicity. Dose-limiting toxicity was defined as failure to maintain cerebral perfusion pressure, triggering cessation of esmolol infusion. The primary outcome was the maximum tolerated dosage schedule of esmolol, defined as that associated with less than 10% probability of dose-limiting toxicity. Secondary outcomes include 6-month mortality and 6-month extended Glasgow Outcome Scale score. Results Sixteen patients (6 [37.5%] female patients; mean age 36 years [standard deviation 13 years]) with a median Glasgow Coma Scale score of 6.5 (interquartile range 5–7) received esmolol. The optimal starting dosage of esmolol was 10 μg/kg/min, with increments every 30 min of 5 μg/kg/min, as it was the highest dosage with less than 10% estimated probability of dose-limiting toxicity (7%). All-cause mortality was 12.5% at 6 months (corresponding to a standardized mortality ratio of 0.63). One dose-limiting toxicity event and no serious adverse hemodynamic effects were seen. Conclusions Esmolol administration, titrated to a heart rate reduction of 15%, is feasible within 24 h of severe traumatic brain injury. The probability of dose-limiting toxicity requiring withdrawal of esmolol when using the optimized schedule is low. Trial registrationI SRCTN, ISRCTN11038397, registered retrospectively January 7, 2021 (https://www.isrctn.com/ISRCTN11038397).

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Systemic and cerebro-cardiac biomarkers following traumatic brain injury: an interim analysis of randomized controlled clinical trial of early administration of beta blockers

El-Menyar,

Asim,

Khan

et al. 2024

Sci Rep

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Beta blockers in traumatic brain injury: a systematic review and meta-analysis

Cited by 5 publications

References 41 publications

Traumatic brain injury and risk of heart failure and coronary heart disease: A nationwide population-based cohort study

Traumatic brain injury and risk of heart failure and coronary heart disease: A nationwide population-based cohort study

Early Intravenous Beta-Blockade with Esmolol in Adults with Severe Traumatic Brain Injury: A Phase 2a Intervention Design Study

Systemic and cerebro-cardiac biomarkers following traumatic brain injury: an interim analysis of randomized controlled clinical trial of early administration of beta blockers

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