Effect of Progesterone Therapy in Traumatic Subarachinoid Haemorrhage on Clinical Outcome, Resistive Vasculer Indices of Middle Cerebral Artery Transcranial Doppler and Thromboelastometry. A Promising Layout
Author(s): Mina M Raouf, Tamer Alzaeem Ismaeel, George Abdelshaheed Hanna, Amr Nady Abdel-Razek, Shery Shehata keriacos
Primary outcome was to investigate progesterone actions on cerebral blood flow velocimetry using trans-cranial doppler and on viscoelastic properties of the coagulation and fibrinolytic system by rotational thrombo-elastometry (ROTEM) scanning. Secondary outcomes were tracking mortality rate and length of ICU stay.
Three hundred thirty two (332) adult patients of both sexes aged 20-65 years, recruited with solo tSAH (no other intra- axial lesions), neuro-critical care. Exclusion criteria included poly-trauma patients (accompanying bone fractures), pre-admission crystalloid infusion > 20 ml/kg, Glasgow coma scale less than 8, red blood cell transfusion during the first 6 hours after admission, history of deep venous thrombosis. Two groups were designed, Control group and Progesterone (PR) group. PR group received 100 mg (2ml) intramuscular seven days once daily from hospital admission, while Control group received intramuscular isotonic saline (2ml) daily for seven days as a placebo. Trans-cranial doppler was performed on admission, two days and seven days post-admission. ROTEM exploited on admission and seven days after admission.
Progesterone ameliorated hyperfibrinolysis by ROTEM scanning without affecting other prameters. Progesterone statistically dampened resistive vascular indices namely pulsatality index (P value =0.001, 0.003) and resistive index (P value=0.001, 0.003) but no effect on mean flow velocity of bilateral middle cerebral artery scanning, Progesterone shortened ICU stay (P value=0.004).
Progesterone can offer neuronal protection in patients with tSAH by impeding over-fibrinolytic activation.