RESUMEN
The influence of statin therapy on cerebral vasomotor function has not been fully characterized. We report the effects of high-dose atorvastatin therapy on cerebral vasomotor reactivity (VMR) in patients with controlled hypertension and dyslipidemia. We prospectively enrolled 36 patients with controlled hypertension and a low-density lipoprotein (LDL) cholesterol concentration >100 mg/dL. Atorvastatin 80 mg was given daily for 6 months and then discontinued. VMR was assessed by hypercapnic and hypocapnic transcranial Doppler challenge in both the right and left middle cerebral artery (MCA) at baseline, and after 3 and 6 months of therapy. Forty-five days after statin cessation, a repeat VMR was performed. VMR impairment was defined as ≤70%. Blood pressure, lipid levels, liver function, and creatine kinase level were monitored. Mean patient age was 60 years, 16 were men, and 13 had a previous history of subcortical infarction. Mean LDL cholesterol level before treatment was 154 ± 30 mg/dL. Atorvastatin lowered LDL by 53% at 3 months and by 46% at 6 months. Baseline VMR was 71% ± 21% in the right MCA and 70% ± 19% in the left MCA. No significant effect of atorvastatin on VMR was seen at 3 months and 6 months in the study population as a whole. In the subgroup of patients with baseline VMR impairment, atorvastatin therapy was associated with significantly improved VMR at both 3 and 6 months. This effect persisted for at least 45 days after discontinuation of therapy. Our findings indicate that high-dose atorvastatin therapy can significantly improve impaired cerebral VMR, and that the effects of atorvastatin on VMR persist for 1.5 months after discontinuation of therapy. We found no benefit of atorvastatin therapy in patients with preserved baseline vasoreactivity.
Asunto(s)
Circulación Cerebrovascular/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Ácidos Heptanoicos/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipercolesterolemia/tratamiento farmacológico , Arteria Cerebral Media/efectos de los fármacos , Pirroles/administración & dosificación , Anciano , Antihipertensivos/uso terapéutico , Atorvastatina , Biomarcadores/sangre , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Infarto Encefálico/etnología , Infarto Encefálico/fisiopatología , Distribución de Chi-Cuadrado , LDL-Colesterol/sangre , Femenino , Florida , Hispánicos o Latinos , Humanos , Hipercolesterolemia/diagnóstico por imagen , Hipercolesterolemia/etnología , Hipercolesterolemia/fisiopatología , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler TranscranealRESUMEN
The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.
Asunto(s)
Hemorragia/terapia , Ácido Aminocaproico/administración & dosificación , Ácido Aminocaproico/efectos adversos , Ácido Aminocaproico/uso terapéutico , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/efectos adversos , Antifibrinolíticos/uso terapéutico , Aprotinina/administración & dosificación , Aprotinina/efectos adversos , Aprotinina/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Sustitutos Sanguíneos/administración & dosificación , Sustitutos Sanguíneos/efectos adversos , Sustitutos Sanguíneos/uso terapéutico , Transfusión de Sangre Autóloga , Coloides/administración & dosificación , Coloides/efectos adversos , Coloides/uso terapéutico , Soluciones Cristaloides , Desamino Arginina Vasopresina/administración & dosificación , Desamino Arginina Vasopresina/efectos adversos , Desamino Arginina Vasopresina/uso terapéutico , Medicina Basada en la Evidencia , Factor VIIa/administración & dosificación , Factor VIIa/efectos adversos , Factor VIIa/uso terapéutico , Hematínicos/administración & dosificación , Hematínicos/efectos adversos , Hematínicos/uso terapéutico , Hemodilución , Hemorragia/tratamiento farmacológico , Hemostáticos/administración & dosificación , Hemostáticos/efectos adversos , Hemostáticos/uso terapéutico , Humanos , Hierro/administración & dosificación , Hierro/efectos adversos , Hierro/uso terapéutico , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/efectos adversos , Soluciones Isotónicas/uso terapéutico , Recuperación de Sangre Operatoria , Hemorragia Posoperatoria/tratamiento farmacológico , Premedicación , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/efectos adversos , Ácido Tranexámico/uso terapéuticoRESUMEN
El Documento de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica (ATSA) ha sido elaborado por un panel de expertos pertenecientes a 5 sociedades científicas. Han participado y patrocinado las sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) y Trombosis y Hemostasia (SETH). Las alternativas a la transfusión se han clasificado en farmacológicas y no farmacológicas, con un total de 4 módulos y 12 tópicos. La disminución de las transfusiones de sangre alogénica y/o el número de pacientes transfundidos fue la principal variable objetivo. El grado de cumplimiento de este objetivo, para cada ATSA, se llevó a cabo siguiendo la metodología Delphi, que clasifica el grado de recomendación desde «A» (apoyado por estudios controlados) hasta «E» (estudios no controlados y opinión de expertos). Los expertos concluyeron que la mayor parte de las indicaciones de las ATSA se sustentan en grados de recomendación medios y bajos, «C», «D» o «E», precisándose nuevos estudios controlados (AU)
The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, «C», «D», or «E», thus indicating the need for further controlled studies (AU)
Asunto(s)
Humanos , Hemorragia/tratamiento farmacológico , Hemorragia/terapia , Ácido Aminocaproico/administración & dosificación , Ácido Aminocaproico/efectos adversos , Ácido Aminocaproico/uso terapéutico , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/efectos adversos , Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Hemodilución , Aprotinina/administración & dosificación , Aprotinina/efectos adversos , Aprotinina/uso terapéutico , Sustitutos Sanguíneos , Transfusión de Sangre Autóloga , Coloides , Proteínas Recombinantes , Soluciones IsotónicasRESUMEN
BACKGROUND: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. OBJECTIVE: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. DESIGN: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. SETTING: Large community-based teaching hospital. PATIENTS: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. MAIN OUTCOME MEASURE: Infarct patterns were analyzed according to established templates of vascular territories. RESULTS: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). CONCLUSIONS: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.