NDLI: Nicotine replacement therapy after subarachnoid hemorrhage is not associated with increased vasospasm.

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Nicotine replacement therapy after subarachnoid hemorrhage is not associated with increased vasospasm.

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Nicotine replacement therapy after subarachnoid hemorrhage is not associated with increased vasospasm.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sims, John R. Carandang, Raphael A. Barton, Bruce Ogilvy, Christopher S. Rordorf, Guy A.
Description	Country affiliation: United States Author Affiliation: Carandang RA ( Department of Neurology, University of Massachusetts Medical School/UMASS Memorial Medical Center, Worcester, MA, USA. raphael.carandang@umassmemorial.org)
Abstract	BACKGROUND AND PURPOSE: A significant number of patients with aneurysmal subarachnoid hemorrhage are active smokers and at risk for acute nicotine withdrawal. There is conflicting literature regarding the vascular effects of nicotine and theoretical concern that it may worsen vasospasm. The literature on the safety of nicotine replacement therapy and its effects on vasospasm is limited. METHODS: A retrospective analysis was conducted of a prospectively collected database of aneurysmal subarachnoid hemorrhage patients admitted to the neurointensive care unit from 1994 to 2008. Paired control subjects matched for age, sex, Fisher score, aneurysm size and number, hypertension, and current medication were analyzed. The primary outcome was clinical and angiographic vasospasm and the secondary outcome was Glasgow Outcome Score on discharge. Conditional logistic models were used to investigate univariate and multivariate relationships between predictors and outcome. RESULTS: Two hundred fifty-eight active smoking patients were included of which 87 were treated with transdermal nicotine replacement therapy. Patients were well matched for age, sex, gender, Fisher score, aneurysm size and number, hypertension, and current medications, but patients who received nicotine replacement therapy had less severe Hunt-Hess scores and Glasgow coma scores. There was no difference in angiographic vasospasm, but patients who received nicotine replacement therapy were less likely to have clinical vasospasm (19.5 versus 32.8%; P=0.026) and a Glasgow Outcome Score <4 on discharge (62.6% versus 81.6%; P=0.005) on multivariate analysis. CONCLUSIONS: Nicotine replacement therapy was not associated with increased angiographic vasospasm and was associated with less clinical vasospasm and better Glasgow Outcome Score scores on discharge.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	11
Volume Number	42
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2011-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Nicotine Administration & Dosage Smoking Cessation Subarachnoid Hemorrhage Drug Therapy Epidemiology Tobacco Use Cessation Products Vasospasm, Intracranial Cohort Studies Adverse Effects Prospective Studies Retrospective Studies Metabolism Comparative Study Research Support, N.i.h., Extramural Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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