The use of a low dose hydrocortisone to prevent pulmonary embolism in patients with multiple trauma

Chaari, Anis; Ghadhoune, Hatem; Chakroune, Olfa; Abid, H.; Turki, Olfa; Bahloul, Mabrouk; Bouaziz, Mounir

doi:10.1007/s11096-013-9775-y

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…compared a prospective cohort of ICU trauma patients provided with steroids with a retrospective control cohort (175 total). 45% of patients were hypotensive but this subgroup was not analysed separately for outcomes 36 . There was a lower incidence of pulmonary embolism but no difference in ICU stay, duration of ventilation or mortality among treated patients 36 …”

Section: Discussionmentioning

confidence: 99%

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Review article: Early steroid administration for traumatic haemorrhagic shock: A systematic review

Hogarty

Jones

Jassal

et al. 2022

Emerg Medicine Australasia

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Haemorrhagic shock after trauma is a leading cause of death worldwide, particularly in young individuals. Despite advances in trauma systems and resuscitation strategies, mortality from haemorrhagic shock has not declined over the previous two decades. A proportion of shocked trauma patients may experience a deficiency of cortisol relative to the severity of their injury. The benefit of exogenous steroid administration in patients suffering haemorrhagic shock as a result of injury is unclear. A systematic review of four databases (Ovid Medline, Ovid Embase, Cochrane, Scopus) was undertaken. Inclusion and exclusion criteria were pre‐determined and two reviewers independently screened the articles with disagreements arbitrated by a third reviewer. The primary outcome variable was 28‐day mortality. Quality of studies were assessed using the Cochrane‐risk‐of‐bias (RoB 2) tool. Of the 2919 studies yielded by the search strategy, 1274 duplicates were removed and 1645 screened on title and abstract. After the full text of 33 studies were assessed, two articles were included. Both studies were over 30 years old with small numbers of participants and with primary outcomes not including mortality. Of the data available, no statistically significant difference in mortality was detected. Hospital length of stay, reversal of shock or adverse events were not reported. Both studies were at risk of bias. There are no high quality or recent studies in the English literature investigating the use of steroids for haemorrhagic shocked trauma patients. PROSPERO: CRD42021239656.

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Section: Discussionmentioning

confidence: 99%

“…45% of patients were hypotensive but this subgroup was not analysed separately for outcomes 36 . There was a lower incidence of pulmonary embolism but no difference in ICU stay, duration of ventilation or mortality among treated patients 36 …”

Section: Discussionmentioning

confidence: 99%

Review article: Early steroid administration for traumatic haemorrhagic shock: A systematic review

Hogarty

Jones

Jassal

et al. 2022

Emerg Medicine Australasia

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“…Focusing on the main stress pathway (HPA axis and SNS), chronic administration of corticosteroid or hypercortisolism (e.g., Cushing's syndrome) enhanced plasma levels of vWF, PAI-1 and FVIII levels, and decreased markers of fibrinolytic activation [50,[97][98][99][100][101][102]. Similarly, the administration of glucocorticoids in healthy subjects increased levels of fibrinogen and vWF [50,[101][102][103], whereas during active inflammation, there were increased levels of PAI-1 but concomitantly decreased levels of VWF and fibrinogen [104], reducing inflammation and the pulmonary embolism in trauma patients [105]. F, factor; a, clotting activity; ag, antigen; vWF, von Willebrand Factor; TAT, thrombin-antithrombin complex; PT, prothrombin time; aPTT, activated partial thromboplastin time; t-PA, tissue-plasminogen activator; PAI-1, plasminogen activator inhibitor-1.…”

Section: Effect Of Stress On Coagulation and Fibrinolytic Cascadementioning

confidence: 99%

Impact of Acute and Chronic Stress on Thrombosis in Healthy Individuals and Cardiovascular Disease Patients

Sandrini

Ieraci

Amadio

et al. 2020

IJMS

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Psychological stress induces different alterations in the organism in order to maintain homeostasis, including changes in hematopoiesis and hemostasis. In particular, stress-induced hyper activation of the autonomic nervous system and hypothalamic–pituitary–adrenal axis can trigger cellular and molecular alterations in platelets, coagulation factors, endothelial function, redox balance, and sterile inflammatory response. For this reason, mental stress is reported to enhance the risk of cardiovascular disease (CVD). However, contrasting results are often found in the literature considering differences in the response to acute or chronic stress and the health condition of the population analyzed. Since thrombosis is the most common underlying pathology of CVDs, the comprehension of the mechanisms at the basis of the association between stress and this pathology is highly valuable. The aim of this work is to give a comprehensive review of the studies focused on the role of acute and chronic stress in both healthy individuals and CVD patients, focusing on the cellular and molecular mechanisms underlying the relationship between stress and thrombosis.

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“…82,83 On the other hand, corticosteroid administration to trauma patients, with the aim of decreasing inflammation that could otherwise trigger the coagulation cascade, has been linked to a reduction in PE events. 84 This may suggest that cortisol possesses acute anticoagulant effects but eventually promotes chronic procoagulant consequences. More research is needed to explore the differential cortisol-time-dependent effects on coagulation during stress.…”

Section: Hpa Axis: Cortisol Effect On Hemostasismentioning

confidence: 99%

Effects of Acute Stress on Thrombosis

Bentur

Sarig

Brenner

et al. 2018

Semin Thromb Hemost

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Stress, the nonspecific response to any demand for change, is an adaptive response of the human body to various stimulants. As such, stress-induced hypercoagulation may represent an adaptive response to bleeding. Numerous epidemiological studies have revealed that a correlation exists between stress and thrombotic risk and biochemically, links of the relationship between psychological stress and coagulation pathways have been made. The stress reaction is coupled with neurohormonal changes mediated mainly by the sympathetic neural system and the hypothalamic-pituitary-adrenal axis. Singling out the specific pathways affecting coagulation in this complex response is hampered by many confounders. The mediators of the stress reaction (neurotransmitters and hormones) can directly affect platelets and the coagulation cascade and indirectly affect hemostasis via changes in hemodynamics. In this review, the authors will delineate the distinct neurobiological mechanisms that govern the effects of stress on coagulation, and report their recent findings.

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The use of a low dose hydrocortisone to prevent pulmonary embolism in patients with multiple trauma

Abstract: Steroids are effective in reducing the incidence of PE in multiple trauma patients. However, no significant benefice was found on ICU mortality.

Cited by 9 publications

References 23 publications

Review article: Early steroid administration for traumatic haemorrhagic shock: A systematic review

Review article: Early steroid administration for traumatic haemorrhagic shock: A systematic review

Impact of Acute and Chronic Stress on Thrombosis in Healthy Individuals and Cardiovascular Disease Patients

Effects of Acute Stress on Thrombosis

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