Short- and Long-Term Opioid Use in Survivors of Subarachnoid Hemorrhage

ObjectiveTo define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH).MethodsRetrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale.ResultsPatients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090–0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19–0.49, p = 0.002).ConclusionsDCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.

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POSTTRAUMATIC STRESS DISORDER EXPLAINS REDUCED QUALITY OF LIFE IN SUBARACHNOID HEMORRHAGE PATIENTS IN BOTH THE SHORT AND LONG TERM

Neurosurgery ◽

10.1227/01.neu.0000327580.91345.78 ◽

2008 ◽

Vol 63 (6) ◽

pp. 1095-1105 ◽

Cited By ~ 68

Author(s):

Adam J. Noble ◽

Stefanie Baisch ◽

Thomas Schenk ◽

A. David Mendelow ◽

Lizanne Allen ◽

...

Keyword(s):

Quality Of Life ◽

Posttraumatic Stress Disorder ◽

Subarachnoid Hemorrhage ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Short And Long Term

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T0901317, an Agonist of Liver X Receptors, Attenuates Neuronal Apoptosis in Early Brain Injury after Subarachnoid Hemorrhage in Rats via Liver X Receptors/Interferon Regulatory Factor/P53 Upregulated Modulator of Apoptosis/Dynamin-1-Like Protein Pathway

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/8849131 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Jiaxing Dai ◽

Shancai Xu ◽

Takeshi Okada ◽

Yu Liu ◽

Gang Zuo ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Neuronal Apoptosis ◽

Early Brain Injury ◽

Interferon Regulatory Factor ◽

Liver X Receptors ◽

Regulatory Factor ◽

Short And Long Term ◽

X Receptors ◽

Crispr Activation

Background and Purpose. T0901317, a liver X receptor (LXR) agonist, is widely used to explore the functions of LXRs. T0901317 exerts antiapoptotic effects in many central nervous system disease models. Our aim was to detect the role of T0901317 in neuronal apoptosis in early brain injury after subarachnoid hemorrhage. Methods. Subarachnoid hemorrhage (SAH) models of Sprague-Dawley rats were established with perforation method. T0901317 was injected intraperitoneally 1-hour post-SAH. GSK2033, an inhibitor of LXRs, and interferon regulatory factor (IRF-1) CRISPR activation were injected intracerebroventricularly to evaluate potential signaling pathway. The severity of SAH, neurobehavior test in both short- and long-term and apoptosis was measured with Western blot and immunofluorescence staining. Results. Expression of LXR-α and IRF-1 increased and peaked at 24 h post-SAH, while LXR-β remained unaffected in SAH+vehicle group compared with Sham group. Post-SAH T0901317 treatment attenuated neuronal impairments in both short- and long-term and decreased neuronal apoptosis, the expression of IRF-1, P53 upregulated modulator of apoptosis (PUMA), dynamin-1-like protein (Drp1), Bcl-2-associated X protein (Bax) and cleaved caspase-3, and increasing B-cell lymphoma 2 (Bcl-2) at 24 h from modeling. GSK2033 inhibited LXRs and reversed T0901317’s neuroprotective effects. IRF-1 CRISPR activation upregulated the expression of IRF-1 and abolished the treatment effects of T0901317. Conclusion. T0901317 attenuated neuronal apoptosis via LXRs/IRF-1/PUMA/Drp1 pathway in SAH rats.

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Role of decompressive craniectomy in the management of poor-grade aneurysmal subarachnoid hemorrhage: short- and long-term outcomes in a matched-pair study

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1817851 ◽

2020 ◽

pp. 1-7

Author(s):

Hai Yu ◽

Liang Guo ◽

Junhua He ◽

Jun Kong ◽

Min Yang

Keyword(s):

Subarachnoid Hemorrhage ◽

Decompressive Craniectomy ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Matched Pair ◽

Long Term Outcomes ◽

Poor Grade ◽

Short And Long Term

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Novel biomarkers to assess in utero effects of maternal opioid use: First steps toward understanding short‐ and long‐term neurodevelopmental sequelae

Genes Brain & Behavior ◽

10.1111/gbb.12583 ◽

2019 ◽

Cited By ~ 3

Author(s):

Laura Goetzl ◽

Tara Thompson‐Felix ◽

Nune Darbinian ◽

Nana Merabova ◽

Salim Merali ◽

...

Keyword(s):

In Utero ◽

Opioid Use ◽

Novel Biomarkers ◽

Short And Long Term

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Short- and long-term outcomes in non-aneurysmal non-perimesencephalic subarachnoid hemorrhage

Neurological Research ◽

10.1080/01616412.2016.1200306 ◽

2016 ◽

Vol 38 (8) ◽

pp. 692-697 ◽

Cited By ~ 5

Author(s):

Aida Lago ◽

Rogelio López-Cuevas ◽

Jose Ignacio Tembl ◽

Gerardo Fortea ◽

David Górriz ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Long Term Outcomes ◽

Perimesencephalic Subarachnoid Hemorrhage ◽

Short And Long Term

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Abstract TP452: Long Term Opioid Use in Patients With Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.tp452 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Idrees Azher ◽

Matthew Anderson ◽

Katarina Dakay ◽

Brian Mac Grory ◽

Scott Moody ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Pain Control ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Control Strategies ◽

Opioid Use ◽

Opioid Prescription ◽

Steroid Use ◽

Number Of Patients ◽

Chronic Opioid Use

Background: Headache and neck pain are common in patients with aneurysmal subarachnoid hemorrhage (aSAH) throughout their course. Because pain is often a sequela, these patients are at risk for opioid dependence. Long term opioid use has not been well studied in this population. Methods: We analyzed a cohort of consecutive patients who were admitted with diagnosis of aSAH to an academic referral center from 2015 to 2018. We excluded patients who died during hospitalization or were discharged to hospice or were previously taking any opioids. The following variables were collected: demographics, any opioid use during hospitalization, short-term low-dose steroid use (mostly for headache management but some cases for immediate post craniotomy for aneurysm clipping), opioid prescription at the time of discharge and 3-month or longer opioid use verified by pharmacy and any follow up out patient records. Results: Of 200 patients with aSAH, 144 patients (72%) met our inclusion criteria. Mean age was 58 years (SD 14.8); Ninety-four patients (65%) were women; All patients received opioids at some point during hospitalization but 66% (96/144) were discharged with opioid prescription. Of these, 31% (30/96) continued to use opioids at ≥3 months. The overall rate of chronic opioid use was 20% (30/144). The rate of opioid prescription at discharge was 72% (52/72) in patients who received short course steroids and 61% (44/72) in patients who did not receive steroids. (p=0.21; OR 2.6, 95% CI 0.82-3.3). Steroids did not prevent long term opioid use. (p=0.30; OR 0.6, 95% CI 0.26-1.3) Conclusion: Opioids are regularly used as the main treatment option for pain control in patients with aSAH. A noteworthy number of patients continue to use opioids beyond their initial hospitalization. Steroid use does not prevent long term opioid use in these patients. Non-opioid pain control strategies should be explored in the future.

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