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Association between sympathetic response, neurogenic cardiomyopathy, and venous thromboembolization in patients with primary subarachnoid hemorrhage

Acta Neurochirurgica volume 155, pages 1501–1510 (2013)Cite this article

Abstract

Introduction

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.

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Acknowledgments

This research was sponsored in part by the Intramural Research Program of the National Institutes of Health. The authors express their gratitude to the nurses of the neurological intensive care unit from the Jefferson Hospital of Neurosciences at Thomas Jefferson University Medical Center for their assistance in this project.

Conflicts of interest

None.

Author information

Affiliations

  1. Neurocritical Care Division, Capital Institute for Neuroscience, Capital Regional Medical Center, 750 Brunswick Avenue, Trenton, NJ, 08638, USA

    Michael Moussouttas

  2. Department of Neurology, Thomas Jefferson Medical Center, Philadelphia, PA, USA

    Meghna Bhatnager, John Khoury & Keith Dombrowski

  3. Medical Neuroendocrinology Section, Program for Reproductive and Adult Endocrinology, National Institutes of Health, Bethesda, MD, USA

    Thanh T. Huynh, Edwin W. Lai & Karel Pacak

  4. Cardiology Division, Department of Medicine, Thomas Jefferson Medical Center, Philadelphia, PA, USA

    Matthew DeCaro

Authors
  1. Michael Moussouttas
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  2. Meghna Bhatnager
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  3. Thanh T. Huynh
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  4. Edwin W. Lai
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  5. John Khoury
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  6. Keith Dombrowski
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  7. Matthew DeCaro
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  8. Karel Pacak
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Correspondence to Michael Moussouttas.

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Collaborations

This work represents a collaboration between the Neurocritical Care Division and Cardiology Division at Thomas Jefferson Medical Center, and the Section on Neuroendocrinology of the Reproductive and Adult Endocrinology Program at the National Institutes of Health.

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Moussouttas, M., Bhatnager, M., Huynh, T.T. et al. Association between sympathetic response, neurogenic cardiomyopathy, and venous thromboembolization in patients with primary subarachnoid hemorrhage. Acta Neurochir 155, 1501–1510 (2013). https://doi.org/10.1007/s00701-013-1725-x

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Keywords

  • Subarachnoid hemorrhage
  • Sympathetic
  • Catecholamine
  • Neurogenic cardiomyopathy
  • Venous
  • Thrombosis