| Transdermal nicotine replacement therapy in cigarette smokers with acute subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 20949331 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: We evaluated the safety of nicotine replacement therapy (NRT) in active smokers with acute (aneurysmal) subarachnoid hemorrhage (SAH). METHODS: A retrospective observational cohort study was conducted in a prospectively collected database including all SAH patients admitted to an 18-bed neuro-ICU between January 1, 2001 and October 1, 2007. Univariate and multivariable models were constructed, employing stepwise logistic regression. The primary endpoint was 3-month mortality. Delayed cerebral ischemia (DCI) due to vasospasm, angiographic and TCD evidence of vasospasm, and delirium were secondary endpoints. RESULTS: Active cigarette smokers admitted with SAH included 128 that received NRT and 106 that did not. Patients were well-matched for age, admission Hunt-Hess Grade, radiographic findings, and APACHE II scores, but those who received NRT were more likely to be heavy smokers (>10 cigarettes daily), diabetic, heavy alcohol users, and to have cerebral edema on admission. NRT was associated in multivariate analysis with a lower risk of death at 3 months (OR 0.12, 95% CI 0.04-0.37, P < 0.001). There were no differences in the frequency of DCI and most other medical complications, but delirium (19 vs. 9%, P = 0.006) and seizures (9 vs. 2%, P = 0.024) were more common in patients who received NRT. CONCLUSIONS: Despite vasoactive properties, administration of NRT among active smokers with acute SAH appeared to be safe, with similar rates of vasospasm and DCI, and a slightly higher rate of seizures. The association of NRT with lower mortality could be due to chance, to uncontrolled factors, or to a neuroprotective effect of nicotine in active smokers hospitalized with SAH, and should be tested prospectively. |
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Authors:
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David B Seder; J Michael Schmidt; Neeraj Badjatia; Luis Fernandez; Fred Rincon; Jan Claassen; Errol Gordon; Emmanuel Carrera; Pedro Kurtz; Kiwon Lee; E Sander Connolly; Stephan A Mayer |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurocritical care Volume: 14 ISSN: 1556-0961 ISO Abbreviation: Neurocrit Care Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101156086 Medline TA: Neurocrit Care Country: United States |
Other Details:
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Languages: eng Pagination: 77-83 Citation Subset: IM |
Affiliation:
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Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA, sederd@mmc.org. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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