Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Miyahara, Kosuke; Murata, Hidetoshi; Abé, Hiroyuki

doi:10.2176/nmc.47.47

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…In cases in which the intraventricular bleeding was concurrently present, the amount of initial bleeding was significantly greater, and the mortality was approximately two times higher. [16,17] According to a study which was conducted in 41 patients with stroke, 31 had a cerebral hemorrhage. Cerebral hemorrhage was developed approximately ten years earlier in the dialysis group than the non-dialysis group.…”

Section: Discussionmentioning

confidence: 99%

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

et al. 2009

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Aims. The incidence of complications associated with cerebrovascular diseases in patients who receive hemodialysis for a long-term period is higher than that of other complications. It is known that mortality due to cerebral hemorrhage is two times higher compared to non-dialysis patients. Anti-coagulants used for hemodialysis are essential. Accordingly, in cases in which the cerebral hemorrhage occurred, the selection of anti-coagulants for the prevention of further bleeding poses a great challenge to physicians. The change of hematoma and patient prognosis has a direct relationship. Many ongoing studies are conducted to examine the causative factors causing the increased hematoma and their related prognostic factors. In the current study, we examined the effect of nafamostat mesylate (a serine protease inhibitor) on the change of hematoma compared to heparin in hemodialysis patients. Methods. The current study was conducted in 17 hemodialysis patients who developed a cerebral hemorrhage. These patients were assigned to two groups based on the type of anti-coagulants that they used (i.e., nafamostat mesylate and heparin). Then, the factors affecting the change of hematoma following the onset of cerebral hemorrhage were examined. The prognosis of hematoma was assessed based on brain CT scans, which were performed two weeks after the onset of cerebral hemorrhage in four groups. Following this, groups 1 (the decreased hematoma) and 2 (the decreased delay) were merged to group A (resolving group), and groups 3 (the increased hematoma) and 4 (the death following the aggravation) were merged to group B (the expansion group) for further analysis. Results. There were no significant differences in baseline characteristics between the nafamostat group and the heparin group. A comparison between the resolving group and the expansion group also showed that there were no significant differences in baseline characteristics. In the anti-coagulants and the change of hematoma, however, there were significant differences between the two groups (p = 0.024). A comparison of the change of hematoma between the four groups was also made. This showed that platelet counts and BUN level were significant factors (Platelet; p = 0.042, BUN; p = 0.043 ANOVA with resolving group). Conclusions. Nafamostat mesylate has a similar profile of anti-coagulative activity to heparin. It is assumed, however, that nafamostat has an affirmative effect on the recovery of damaged sites following the onset of cerebral hemorrhage. It is an anti-coagulant that can be safely used for hemodialysis following the onset of cerebral hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

et al. 2009

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“…35 Other investigators have applied various shape definitions in studies of amyloid and hypertensive bleeds (round, lobular, or irregular), 36 warfarin-related hemorrhages (round to ellipsoid with smooth margins, irregular with frayed margins, multinodular to separated), 28 and in an analysis of ICH growth predictors in a small study of patients undergoing hemodialysis (round and irregular groups). 37 In contrast, we used a scale that was validated by testing within-and between-observer agreement, studied patients at relatively homogeneous times after onset of symptoms, and used standardized growth definitions. These scales are the first attempt to visually categorize the spectrum of shape and density variation in ICH morphology.…”

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confidence: 99%

Density and Shape as CT Predictors of Intracerebral Hemorrhage Growth

Barras

Tress

Christensen

et al. 2009

Stroke

251

165

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Background and Purpose-Intracerebral hemorrhage (ICH) growth predicts mortality and functional outcome. We hypothesized that irregular hematoma shape and density heterogeneity, reflecting active, multifocal bleeding or a variable bleeding time course, would predict ICH growth. Methods-Three raters examined baseline sub-3-hour CT brain scans of 90 patients in the placebo arm of a Phase IIb trial of recombinant activated Factor VII in ICH. Each rater, blinded to growth data, independently applied novel 5-point categorical scales of density and shape to randomly presented baseline CT images of ICH. Density and shape were defined as either homogeneous/regular (Category 1 to 2) or heterogeneous/irregular (Category 3 to 5). Within-and between-rater reliability was determined for these scales. Growth was assessed as a continuous variable and using 3 binary definitions: (1) any ICH growth; (2) Ն33% or Ն12.5 mL ICH growth; and (3) radial growth Ͼ1 mm between baseline and 24-hour CT scan. Patients were divided into tertiles of baseline ICH volume: "small" (0 to 10 mL), "medium" (10 to 25 mL), and "large" (25 to 106 mL). Results-Inter-and intrarater agreements for the novel scales exceeded 85% (Ϯ1 category). Median growth was significantly higher in the large-volume group compared with the small group (PϽ0.001) and in heterogeneous compared with homogeneous ICH (Pϭ0.008). Median growth trended higher in irregular ICHs compared with regular ICHs (Pϭ0.084). Small ICHs were more regularly shaped (43%) than medium (17%) and large (3%) ICHs (PϽ0.001). Small ICHs were more homogeneous (73%) compared with medium (37%) and large (17%) ICHs (PϽ0.001). Adjusting for baseline ICH volume and time to scan, density heterogeneity, but not shape irregularity, independently predicted ICH growth (Pϭ0.046) on a continuous growth scale. Conclusions-LargeICHs were significantly more irregular in shape, heterogeneous in density, and had greater growth.Density heterogeneity independently predicted ICH growth using some definitions. Key Words: density Ⅲ growth Ⅲ intracerebral hemorrhage Ⅲ recombinant activated factor VII Ⅲ predictors Ⅲ shape I ntracerebral hemorrhage (ICH) is the most sinister stroke subtype with a high early mortality. 1,2 Despite this, there is convincing evidence that aggressive care can bring about meaningful recovery, even in the worst initial prognostic groups. 3,4 CT scanning remains the standard diagnostic technique for ICH. Hematoma growth occurs in Ͼ70% of patients on CT performed within 3 hours of symptom onset and independently predicts mortality and functional outcome. 5 Hemostatic therapy has been demonstrated to attenuate ICH growth in 2 pivotal studies of recombinant activated Factor VII administered within 4 hours of symptom onset. 6,7 In contrast, the clinical outcomes in these trials were discordant and the positive results were not replicated in the second, larger trial. 6,7 Attenuated hematoma growth has also been suggested in an acute blood pressure reduction trial. 8 Hence, hematoma growth is a key therapeu...

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“…In this study, we showed that the mortality rates were not significantly different for the EHD and CPD patients. In addition, our patients had a relatively lower mortality rate (total mortality 27.9%) than other series (mean mortality 62.1%, range 43.8–67.3%) [7,8,10,11,16,17,18]. The mean outcome score was 3 in the CPD and 2 in the EHD groups, respectively.…”

Section: Discussionmentioning

confidence: 47%

“…The prognosis of ICH in chronic dialysis patients is especially poor. The 30-day mortality rate has been reported to be as high as 67.3% (range 43.8–67.3%) [7,8,10,11,16,17,18]. The total 30-day mortality rate of our patients was 27.9%.…”

Section: Discussionmentioning

confidence: 54%

“…ICH in a chronic dialysis population occurs 10 years earlier than in the general population, and has an especially poor prognosis [3,4,5,6]. Furthermore, due to the associated tendency for bleeding, the hematomas of ICH patients undergoing HD are reported to be larger and more likely to increase in size after symptom onset [6,7,8]. ESRD patients who suffer from ICH have a mortality rate twice that of non-ESRD patients with ICH [8].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

Hsieh

Chen

et al. 2010

Am J Nephrol

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Background/Aims: The optimal mode of dialysis for end-stage renal disease (ESRD) patients with spontaneous intracerebral hemorrhage (ICH) remains controversial. We compared the outcomes of ESRD patients who received continuous peritoneal dialysis (CPD) or extended hemodialysis (EHD) after ICH, and investigated the factors determining prognosis.Methods: We incorporated our ICH patients with ESRD, requiring dialysis from January 2005 to December 2009. Patients were allocated to the CPD or EHD group according to the dialysis mode after ICH. We compared the 30-day mortality rate and modified Rankin Scale (mRS) of the two groups and analyzed the factors associated with mortality. Results: There were 40 patients with 16 episodes in CPD and 27 episodes in EHD group, without significant differences in baseline demographic data. The 30-day mortality rate and mRS were not different between the two groups. The patients who died within 30 days had higher ICH scores (4 ± 1 vs. 1 ± 1, p < 0.001) and outcome scores (5 ± 2 vs. 1 ± 1, p < 0.001). Dialysis-related complications occurred more frequently in the PD group (p = 0.07), but were unrelated to mortality. Conclusion: Among ESRD patients with ICH, EHD had a similar 30-day mortality rate and 30-day mRS to those receiving CPD. The mortality was significantly related to the severity of ICH.

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Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Cited by 16 publications

References 13 publications

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

Superior Outcome of Nafamostat Mesilate as an Anticoagulant in Patients Undergoing Maintenance Hemodialysis with Intracerebral Hemorrhage

Density and Shape as CT Predictors of Intracerebral Hemorrhage Growth

Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

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