Spontaneous intracerebral hemorrhage in critically ill patients: incidence over six years and associated factors

Oppenheim-Eden, Arieh; Glantz, Lucio; Eidelman, Leonid A.; Sprung, Charles L.

doi:10.1007/s001340050788

Cited by 49 publications

(26 citation statements)

References 16 publications

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“…Type and acuity of illness as well as presence of fever, sepsis, multiple organ failure, coagulopathy, medication, and platelet function have to be evaluated. Thus, hypertension and sepsis are frequently associated in patients with intracerebral hemorrhage after liver transplantation [2,24], as in critically ill patients [26].…”

Section: Discussionmentioning

confidence: 99%

Effect of severe thrombocytopenia on patient outcome after liver transplantation

et al. 2003

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Section: Discussionmentioning

confidence: 99%

Effect of severe thrombocytopenia on patient outcome after liver transplantation

et al. 2003

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“…8,9 Patients with DIC and a platelet count of <50x10 9 /l have a 4 to 5-fold higher risk for bleeding as compared to patients with a higher platelet count. [10][11][12] More common is the occurrence of thrombosis in small and midsize vessels contributing to organ failure in patients with DIC, with reported ranges from 10-15% in patients with cancer or trauma up to 40% in patients with sepsis, although these estimates may not be very precise. 13,14 A variety of organs in patients with DIC show intravascular fibrin deposition at pathological examination related to the clinical dysfunction of the organs.…”

Section: Introductionmentioning

confidence: 99%

How I treat disseminated intravascular coagulation

Levi

Scully

2018

Blood

211

191

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Disseminated intravascular coagulation (DIC) is a condition characterised by systemic activation of coagulation, potentially leading to thrombotic obstruction of small and midsize vessels, thereby contributing to organ dysfunction. At the same time, ongoing consumption of platelets and coagulation proteins results in thrombocytopenia and low concentrations of clotting factors, which may cause profuse hemorrhagic complications. DIC is always secondary to an underlying condition, such as severe infections, solid or hematologic malignancies, trauma, or obstetric calamities. A reliable diagnosis of DIC can be made through simple scoring algorithms based on readily available routine hemostatic parameters. The cornerstone of supportive treatment of this coagulopathy is management of the underlying condition.

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“…Serious adverse bleeding events in randomized trials occurred at consistently low rates. Moreover, the incidence of intracranial hemorrhage across all studies is comparable to the rate of spontaneous intracranial hemorrhage observed in critically ill patients [ 21 ]. The risk for bleeding can be mitigated by following package inserts (approved labeling) and avoiding off-label use (in contraindicated patients).…”

Section: Safetymentioning

confidence: 85%

Current role of activated protein C therapy for severe sepsis and septic shock

Barie

2008

Curr Infect Dis Rep

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Drotrecogin alfa (activated) (DrotAA) has been approved for therapy of severe sepsis and septic shock for 7 years, but controversy persists regarding efficacy and safety. Only a single randomized, controlled trial (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis; PROWESS) has shown evidence of efficacy, and the risk of complications (especially hemorrhage) is recognized. Moreover, subsequent prospective studies (albeit in children and lower-risk adult patient populations) have been nonconfirmatory. Opinion is polarized whether DrotAA is effective and should be used. Safety data are not in dispute (DrotAA therapy increases risk of bleeding complications), but controversy exists regarding efficacy, the ethics of marketing the drug, and the design and conduct of current and future trials designed to resolve efficacy questions. DrotAA is approved therapy in the United States, the European Union, and many other countries, and clinicians should keep the drug in their armamentarium, balancing risk and benefit, for therapy of patients with severe sepsis or septic shock who are at high risk of death until the controversy is resolved by randomized, prospective trials now in progress.

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Spontaneous intracerebral hemorrhage in critically ill patients: incidence over six years and associated factors

Abstract: Spontaneous nonhypertensive ICH is a rare, fatal event in the ICU. Associated factors include thrombocytopenia, the need for mechanical ventilation, elevated PIP and PaCO2, sepsis, and impaired hepatic and renal function.

Cited by 49 publications

References 16 publications

Effect of severe thrombocytopenia on patient outcome after liver transplantation

Effect of severe thrombocytopenia on patient outcome after liver transplantation

How I treat disseminated intravascular coagulation

Current role of activated protein C therapy for severe sepsis and septic shock

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