No abstract

FA and NAA/Cr hold potential as quantitative outcome-prediction tools at the subacute phase of TBI.

Mean daily value of S100B assessed during the first 8 days is a prognostic tool complementary to initial clinical evaluation in subarachnoid hemorrhage patients.

S100B elevation over the first 15 days after subarachnoid aneurysmal hemorrhage is associated with poor outcome after subarachnoid aneurysmal hemorrhage. This result supports the use of S100B as a surrogate marker for brain ischemia in patients with subarachnoid aneurysmal hemorrhage.

The use of this panel, including four brain injury-related proteins, one cardiac marker and a clinical score, could be a valuable tool to identify aSAH patients at risk of poor outcome.

Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1-3) after 1 year.

AimRecent studies have suggested that intravenous (i.v.) enoxaparin could be used as antithrombotic therapy in patients ongoing percutaneous coronary intervention (PCI). However, anti-Xa pharmacokinetics following different i.v. dosing regimens is not clearly established. MethodsA population pharmacokinetic analysis was developed using anti-Xa activities measured in 546 patients who received a single 0.5 mg kg -1 i.v. dose of enoxaparin immediately before PCI. Effects of higher doses (0.75 mg kg -1 and 1 mg kg -1 ) and/ or additional bolus after the initial administration were similarly simulated. ResultsEnoxaparin anti-Xa time profiles were best described by a one-compartment model with zero-order kinetics. Mean population parameters (intersubject variability, %) were CL 1.2 l h -1 (33), V 2.9 l (30) and zero-order input 0.25 h (24). With a single bolus of 0.5 mg kg -1 , the totality of the patients reached an effective anticoagulation level (anti-Xa > 0.5 IU ml -1 ) and only 2.5% reached levels above 1.5 IU ml -1 . Simulations showed that greater doses (0.75 mg kg -1 and 1 mg kg -1 ) prolonged the duration of anticoagulation (3.4 and 4.1 h, respectively) compared with the 0.5 mg kg -1 bolus (2.7 h) and markedly increased the proportion (48% and 79%, respectively) of patients with anti-Xa levels > 1.5 IU ml -1 . For delayed and/or prolonged procedures, patients could be administered a second bolus of half the initial dose in a time interval between 90 min to 2 h after in order to maintain similar anticoagulation profile levels. ConclusionsA single 0.5 mg kg -1 i.v. dose of enoxaparin reached anticoagulation levels adequately and should be safer compared with greater doses for anticoagulation in patients undergoing an elective PCI. An additional second bolus could be proposed in patients with delayed or prolonged procedures. Intravenous enoxaparin in patients undergoing PCIBr J Clin Pharmacol 60 :4 365

Atorvastatin reduces the incidence, the severity and the ischemic consequences of vasospasm as assessed on computed tomography. In high-grade World Federation of Neurological Surgeons patients, atorvastatin decreases serum levels of S100B, a biomarker of brain ischemia. Despite these positive effects on biomarkers, no improvement of outcome was seen in the overall population, although there was a tendency for a better clinical outcome in high-grade patients.