Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2020
Observational StudyAn 18-month single-center observational study of real-world use of andexanet alfa in patients with factor Xa inhibitor associated intracranial hemorrhage.
Intracranial hemorrhage is a life threatening complication of factor Xa inhibitors. Except for results of the open-label, single-arm ANNEXA-4 study, published real-world utilization of andexanet alfa is limited. We present our experience with andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. The objective of this study was to assess the hemostatic efficacy and safety following early implementation of andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. ⋯ In this cohort of a real-world utilization of andexanet alfa for reversal of factor Xa inhibitors in patients presenting with intracranial hemorrhage, we observed a high excellent/good hemostatic efficacy rate and lower than reported inpatient mortality and 30-day readmission due to thromboembolism consistent with the findings reported in ANNEXA-4 study. Despite the lack of comparative group, our outcomes, most noticeably hemostatic efficacy and inpatient mortality are consistent with those reported in the literature.
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Clin Neurol Neurosurg · Aug 2020
Review Meta AnalysisMonoclonal antibodies as a preventive therapy for migraine: A meta-analysis.
Calcitonin gene-related peptide (CGRP) antagonists have recently grabbed the attention of clinicians for migraine prophylaxis. The present meta-analysis aimed to assess the efficacy and safety of CGRP monoclonal antibodies (mAbs) in patients with chronic and episodic migraine using a systematic therapeutic regimen. More specifically, double-blind placebo-controlled randomized clinical trials (RCTs) which assessed the therapeutic potential of monthly subcutaneous injections were included. ⋯ No significant differences between groups were noted in TRAEs. CGRP mAbs provide highly efficacious and safe outcomes which start early after the first injection. The tolerability of these medications surpasses that of other small-molecule CGRP antagonists.
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Clin Neurol Neurosurg · Aug 2020
Meta AnalysisHyperbaric oxygen therapy for post-stroke depression: A systematic review and meta-analysis.
Post-stroke depression (PSD) is common consequence of stroke. However, today the majority of PSD patients remains untreated or inadequately treated, especially in the developing countries. Herein, we performed a meta-analysis to evaluate efficacy and safety of hyperbaric oxygen (HBOT) therapy for PSD. ⋯ Based on our pooled analysis, HBOT is effective and safe therapeutic approach for PSD. However, results should be cautiously interpreted due to a relatively poor methodological quality.
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Clin Neurol Neurosurg · Aug 2020
Associated risk factors for extended length of stay following anterior cervical discectomy and fusion for cervical spondylotic myelopathy.
There is a paucity of literature describing the predictors associated with extended length of hospital stay (LOS) for patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. The aim of this study was to identify the patient- and hospital-level factors associated with extended LOS for patients with cervical spondylotic myelopathy undergoing ACDF. ⋯ Our national cohort study demonstrated multiple patient- and hospital-level factors associated with extended LOS (>3 days) after ACDF for CSM. Specifically, patients with an extended LOS had lower socioeconomic status, higher rate of comorbidities, greater percentage of postoperative complications and non-routine discharges, with greater overall costs. Further investigational studies are necessary to identify quality improvement strategies targeted to better optimizing patients preoperatively and reducing perioperative complications in order to improve quality of patient care and reduce hospital LOS.
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Clin Neurol Neurosurg · Aug 2020
The incidence of symptomatic postoperative epidural hematoma after minimally invasive lumbar decompression: A single institution retrospective review.
Postoperative epidural hematoma (PEDH) after minimally invasive lumbar laminectomy (MILL) can lead to significant morbidity and healthcare cost. The incidence is not well characterized in the literature as compared with traditional open techniques. Our aim was to define the incidence of PEDH after MIS lumbar decompression procedures and evaluate strategies for reduction of PEDH. ⋯ The rate of PEDH after MIS lumbar decompression procedures is 1.4 %. A majority of patients presented with a neurological deficit.