Document Detail

Spinal haemorrhage during anticoagulant regimen for thromboprophylaxis: a unique form of central nervous system haemorrhage.
MedLine Citation:
PMID:  22566595     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The management of anticoagulation (AC) therapy in patients with central nervous system (CNS) haemorrhage remains challenging. This study examines the potential factors associated with spinal haematoma among patients who develop CNS haemorrhage while on AC therapy.
METHODS: Based on a systematic review using MEDLINE and EMBASE, two reviewers screened publications and extracted data on all CNS-haemorrhage cases. First, all cases were grouped into brain, posterior fossa and spinal haemorrhage. Second, the spinal-haemorrhage group was subdivided into those patients experiencing complete neurological recovery, incomplete recovery, no recovery and death. Finally, axonal survival and inflammatory response after spinal cord injury (SCI) due to trauma and spinal haemorrhage were examined using postmortem spinal cord tissue.
RESULTS: Data were extracted from 72 publications including 553 patients. There were significant differences among the CNS groups regarding patient characteristics and management, while their outcomes were comparable. Outcomes among the spinal-haemorrhage subgroups were not associated with patient characteristics and management. Postmortem examination of spinal cord showed that axonal survival and inflammatory response in a spinal-haemorrhage case were similar to a case of traumatic SCI.
CONCLUSIONS: The results of this study suggest that the management of patients with spinal haemorrhage considerably differ from individuals with an intracranial haemorrhage during AC. However, survival and neurological recovery appear to be comparable among the CNS groups. The studied factors failed to discriminate the patient subgroups according to survival and neurological recovery. Finally, the neuropathology result reinforces the possibility that the mechanism of SCI may not be relevant for axonal survival and inflammatory response within the spinal cord.
Julio C Furlan; Gregory W Hawryluk; James Austin; Michael G Fehlings
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-05-07
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  83     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-05     Completed Date:  2012-08-16     Revised Date:  2012-12-07    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  746-52     Citation Subset:  IM    
Toronto Western Research Institute, Toronto, Ontario, Canada.
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MeSH Terms
Anticoagulants / adverse effects*,  therapeutic use
Hemorrhage / chemically induced*,  pathology
Intracranial Hemorrhages / chemically induced,  etiology
Myelitis / complications,  pathology
Spinal Cord / pathology
Spinal Cord Diseases / chemically induced*,  etiology,  pathology
Spinal Cord Injuries / complications,  pathology
Treatment Outcome
Reg. No./Substance:

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