Dexamethasone helps outcome in hemorrhagic stroke patients

9:56 AM Posted by Dr Subhash Kumar, MBBS, MD, DM


There has always been a debate whether steroids are beneficial in management of hemorrhagic stroke with many neurologists not favoring it citing lack of clinical evidence even though there has been enough basic research. Now a large blinded study comparing a large group of patients in two centers have been made available and clearly shows clinical benefits of dexamethasone.

A Comparison of Acute Hemorrhagic Stroke Outcomes in 2 Populations

The Crete–Boston Study

  1. Ioannis Zaganas, MD, PhD;
  2. Amy P. Halpin, BS;
  3. Alexandra Oleinik, BA;
  4. Athanasios Alegakis, PhD;
  5. Dimitra Kotzamani, MD;
  6. Spiros Zafiris, MD;
  7. Chryssanthi Chlapoutaki, MD;
  8. Dimitris Tsimoulis, MD;
  9. Emmanouil Giannakoudakis, MD;
  10. Nikolaos Chochlidakis, MD;
  11. Aikaterini Ntailiani, MD;
  12. Christina Valatsou, MD;
  13. Efrosini Papadaki, MD, PhD;
  14. Antonios Vakis, MD, PhD;
  15. Karen L. Furie, MD;
  16. Steven M. Greenberg, MD, PhD;
  17. Andreas Plaitakis, MD, PhD

From the Neurology (I.Z., D.K., S.Z., C.C., D.T., E.G., A.P.), Toxicology (A.A.), Neurosurgery (N.C., A.V.), and Radiology (A.N., C.V., E.P.), Departments, University Hospital of Heraklion, Crete, Greece; and the Stroke Service (A.P.H., A.O., K.L.F., S.M.G.), Massachusetts General Hospital, Boston, MA.
  1. Correspondence to Andreas Plaitakis, MD, PhD, Professor and Chairman,Department of Neurology, University Hospital of Heraklion, Voutes, 71021, Heraklion, Crete, Greece. E-mail plaitakis@yahoo.com

Abstract

Background and Purpose—Although corticosteroid use in acute hemorrhagic stroke is not widely adopted, management with intravenous dexamethasone has been standard of care at the University Hospital of Heraklion, Crete with observed outcomes superior to those reported in the literature. To explore this further, we conducted a retrospective, multivariable-adjusted 2-center study.
Methods—We studied 391 acute hemorrhagic stroke cases admitted to the University Hospital of Heraklion, Crete between January 1997 and July 2010 and compared them with 510 acute hemorrhagic stroke cases admitted to Massachusetts General Hospital, Boston, from January 2003 to September 2009. Of the Cretan cases, 340 received a tapering scheme of intravenous dexamethasone, starting with 16 to 32 mg/day, whereas the Boston patients were managed without steroids.
Results—The 2 cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0%, n=510; P<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510; P<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359;P<0.001). The improved survival on Crete was observed 3 days after initiation of intravenous dexamethasone and was pronounced for deep-seated hemorrhages. After adjusting for acute hemorrhagic stroke volume/location, Glasgow Coma Scale, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet, and anticoagulant use, intravenous dexamethasone treatment was associated with better functional outcomes and significantly lower risk of death at 30 days (OR, 0.357; 95% CI, 0.174–0.732).
Conclusions—This study suggests that intravenous dexamethasone improves outcome in acute hemorrhagic stroke and supports a randomized clinical trial using this approach.

http://stroke.ahajournals.org/content/early/2011/10/19/STROKEAHA.111.632174.abstract


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