title: Association between sympathetic response, neurogenic cardiomyopathy, and venous thromboembolization in patients with primary subarachnoid hemorrhage.
abstract: BACKGROUND
  Sympathetic activation promotes hemostasis, and subarachnoid hemorrhage (SAH) is associated with pronounced sympathetic activation. This investigation will assess whether catecholaminergic activity relates to venous thrombotic events in patients with acute SAH.
  
  
  METHODS
  Observational study of consecutive SAH grade 3-5 patients requiring ventriculostomy insertion who did not undergo open surgical treatment of cerebral aneurysm. Cerebrospinal fluid (CSF) samples were obtained within 48 h of hemorrhage for assay of catecholamines, which were related to occurrence of deep venous thrombosis (DVT) and pulmonary embolization (PE).
  
  
  RESULTS
  Of the 92 subjects, mean age was 57 years, 76% were female, and 57% Caucasian; 11% experienced lower extremity (LE) DVT, 12% developed upper extremity (UE) or LE DVT, and 23% developed any DVT/PE. Mean time to occurrence of UE/LE DVT was 7.8 days (+/-5.9 days), and mean time to development of PE was 8.8 days (+/-5.4 days). In hazards analysis models, independent predictors of LE DVT included neurogenic cardiomyopathy (NC) [HR 4.97 (95%CI 1.32-18.7)], norepinephrine/3,4-dihydroxyphenylglycol ratio (NE/DHPG) [3.81 (2.04-7.14)], NE [5.91 (2.14-16.3)], and dopamine (DA) [2.27 (1.38-3.72)]. Predictors of UE/LE DVT included NC [5.78 (1.70-19.7)], cerebral infarction [4.01 (1.18-13.7)], NE [3.58 (1.40-9.19)], NE/DHPG [3.38 (1.80-6.33)] and DA [2.01 (1.20-3.35)]. Predictors of DVT/PE included Hunt-Hess grade (H/H) [3.02 (1.19-7.66)], NE [2.56 (1.23-5.37)] and 3,4-dihydroxyphenylalanine (DOPA) [3.49 (1.01-12.0)].
  
  
  CONCLUSIONS
  In severe SAH, central sympathetic activity and clinical manifestations of (nor)adrenergic activity relate to the development of venous thromboemboli. Catecholamine activation may promote hemostasis, or may represent a biomarker for venous thromboses.
authors: Neurocritical Care Division, Capital Institute for Neuroscience, Capital Regional Medical Center, 750 Brunswick Avenue, Trenton, NJ 08638, USA. moussouttas@hotmail.com
authors: Michael
authors: M
authors: Moussouttas
authors: Meghna
authors: M
authors: Bhatnager
authors: Thanh T
authors: TT
authors: Huynh
authors: Edwin W
authors: EW
authors: Lai
authors: John
authors: J
authors: Khoury
authors: Keith
authors: K
authors: Dombrowski
authors: Matthew
authors: M
authors: DeCaro
authors: Karel
authors: K
authors: Pacak
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D009202:Cardiomyopathies / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D002395:Catecholamines / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000031:analogs & derivatives / Q000134:cerebrospinal fluid; D008875:Middle Aged; D009638:Norepinephrine / Q000134:cerebrospinal fluid; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000601:surgery; D013923:Thromboembolism / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery; D014696:Ventriculostomy / Q000379:methods
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D008734:Methoxyhydroxyphenylglycol; C010117:3,4-dihydroxyphenylglycol; D009638:Norepinephrine