ABSTRACT
BACKGROUND: Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin. METHODS: In this retrospective cohort study, we questioned whether prophylactic (1â¯mg) and therapeutic (7⯵g/kg) intravenous cosyntropin following unintentional dural puncture (UDP) was effective in decreasing the incidence of PDPH and therapeutic epidural blood patch (EBP) after birth. Two tertiary-care American university hospitals collected data from November 1999 to May 2017. Two hundred and fifty-three postpartum patients who experienced an UDP were analyzed. In one institution 32 patients were exposed to and 32 patients were not given prophylactic cosyntropin; in the other institution, once PDPH developed, 36 patients were given and 153 patients were not given therapeutic cosyntropin. The primary outcome for the prophylactic cosyntropin analysis was the incidence of PDPH and for the therapeutic cosyntropin analysis in exposed vs. unexposed patients, the receipt of an EBP. The secondary outcome for the prophylactic cosyntropin groups was the receipt of an EBP. RESULTS: In the prophylactic cosyntropin analysis no significant difference was found in the risk of PDPH between those exposed to cosyntropin (19/32, 59%) and unexposed patients (17/32, 53%; odds ratio (OR) 1.37, 95% CI 0.48 to 3.98, Pâ¯=â¯0.56), or in the incidence of EBP between exposed (12/32, 38%) and unexposed patients (6/32, 19%; OR 2.6, 95% CI 0.83 to 8.13, Pâ¯=â¯0.095). In the therapeutic cosyntropin analysis, in patients exposed to cosyntropin the incidence of EBP was significantly higher (20/36, 56% vs. 43/153, 28%; OR 3.20, 95% CI 1.52 to 6.74, Pâ¯=â¯0.002). CONCLUSIONS: Our data show no benefits from the use of cosyntropin for preventing or treating postpartum PDPH.
Subject(s)
Post-Dural Puncture Headache , Female , Humans , Post-Dural Puncture Headache/etiology , Cosyntropin , Retrospective Studies , Postpartum Period , Spinal Puncture/adverse effects , Uridine Diphosphate , Blood Patch, Epidural/adverse effectsSubject(s)
Brain Injuries/therapy , Hemoperfusion , Adult , Critical Care , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
Aggregation and rheological properties of blood were evaluated in 20 atherosclerotic patients after cryoplasmosorption. The change of the patients' plasma for extracorporeally modified autoplasma reduced coagulation potential, enhanced fibrinolysis and suppressed anticoagulation systems. Clinical efficacy manifested in decreased frequency and duration of anginal episodes, intensity of intermittent claudication. Biochemically, cholesterol levels and atherogenic index lowering was evident.
