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Transdermal nicotine replacement therapy in cigarette smokers with acute subarachnoid hemorrhage.
MedLine Citation:
PMID:  20949331     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Neurocritical care     Volume:  14     ISSN:  1556-0961     ISO Abbreviation:  Neurocrit Care     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  77-83     Citation Subset:  IM    
Affiliation:
Department of Critical Care Services, Neuroscience Institute, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA, sederd@mmc.org.
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