1.
A Comparison Between Enteral and Intravenous Nimodipine in Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis
Geraldini F, De Cassai A, Diana P, Correale C, Boscolo A, Zampirollo S, Disarò L, Carere A, Cacco N, Navalesi P, et al
Neurocritical care. 2022
Abstract
Our objective was to compare the effectiveness of intravenous and enteral nimodipine in preventing poor outcome from delayed cerebral ischemia in patients with subarachnoid hemorrhage. We performed a systematic search and a network meta-analysis using the following databases: PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Google Scholar. Risk of Bias 2 tool was used to assess risk of bias of included studies. A ranking among methods was performed on the basis of the frequentist analog of the surface under the cumulative ranking curve. Published studies that met the following population, intervention, comparison, outcomes and study (PICOS) criteria were included: patients with subarachnoid hemorrhage aged 15 years or older (P); nimodipine, intravenous and oral formulation (I); placebo or no intervention (C); poor outcome measured at 3 months (defined as death, vegetative state, or severe disability), case fatality at 3 months, delayed cerebral ischemia, delayed ischaemic neurologic deficit, and vasospasm measured with transcranial Doppler or digital subtraction angiography (O); and randomized controlled trials (S). No language or publication date restrictions were applied. Ten studies were finally included, with a total of 1527 randomly assigned patients. Oral and intravenous nimodipine were both effective in preventing poor outcome, delayed cerebral ischemia, and delayed ischaemic neurological deficit. Neither treatment was effective in improving case fatality. Evolving clinical protocols over a 30-year period and the risk of bias of the included studies may limit the strength of our results. Enteral and intravenous nimodipine may have a similar effectiveness in terms of preventing poor outcome, delayed cerebral ischemia, and delayed ischaemic neurological deficit. More research may be needed to fully establish the role of intravenous nimodipine in current clinical practice.
2.
Neuraxial and Perineural Bleeding after Neuraxial Techniques: An Overview of the Last Year
De Cassai A, Correale C, Sandei L
Eurasian J Med. 2020;52(2):211-216
Abstract
Spinal hematoma following neuraxial or perineural techniques is a rare but severe complication that can potentially lead to catastrophic consequences. The aim of this review is to analyze all reported cases of neuraxial or perineural bleeding after performance of a locoregional technique since the last guidelines update in 2018. We included articles indexed by MEDLINE, Scopus, and Google Scholar. We analyzed the patient's age, surgical procedure, pre-operative anticoagulant and antiplatelet therapy, type of anesthetic procedure, vertebra level of the procedure, diameter and point type of the needle, hematoma type (spinal, subdural, epidural), signs and symptoms, time to imaging, and time to treatment and outcome. During our bibliographic research, we identified 5637 unique articles that were eligible according to our protocol criteria, identifying 18 separate cases of neuraxial bleeding. Although clinicians are usually aware of antiplatelet and anticoagulant perioperative management, a careful post-procedural observation and a detailed patient education are also imperative for the early detection of the symptoms of spinal cord ischemia.
3.
Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis
Boscolo A, Spiezia L, De Cassai A, Pasin L, Pesenti E, Zatta M, Zampirollo S, Andreatta G, Sella N, Pettenuzzo T, et al
Journal of critical care. 2020;61:5-13
Abstract
BACKGROUND Thromboelastometry/elastography (ROTEM/TEG) showed promising results for diagnosis of sepsis-induced coagulopathy, but their association with the outcome is unclear. Our aim was to assess any difference in ROTEM/TEG measurements between septic survivors and non-survivors. METHODS Pubmed, Web of Science, Embase and Cochrane Library databases were investigated. The research aimed to include any randomized or observational study: i) on septic adult patients admitted to Intensive Care Unit (ICU) or Emergency Department (ED); ii) including ROTEM/TEG; iii) assessing mortality. RESULTS Seven prospective and four retrospective observational studies (952 patients) were included. According to the INTEM/kaolin-assay, clotting time (CT)/R (standardized mean difference(SMD) -0.29, 95% CI -0.49 to -0.09, p = 0.004) and clot formation time (CFT)/K (SMD -0.42, 95% CI -0.78 to -0.06, p = 0.02) were shorter in survivors. According to the EXTEM-assay, CT was shorter (MD -11.66 s, 95% CI -22.59 to -0.73, p = 0.04), while MCF was higher (MD 3.49 mm, 95% CI 0.43 to 6.55, p = 0.03) in survivors. A hypocoagulable profile was more frequent in non-survivors (OR 0.31, 95%CI 0.18 to 0.55, p < 0.0001). Overall, the risk of bias of the included studies was moderate and the quality of evidence low. CONCLUSIONS Hypocoagulability and lower MCF in EXTEM may be associated with higher mortality in sepsis.