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  • Deferoxamine Accelerates Hemorrhage Absorption for Patients With Traumatic Intracerebral Hematoma: A Prospective Randomized Controlled Trial

    Final Number:
    186

    Authors:
    Jian Yu MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Traumatic brain injury (TBI) is a common disease for adult, particularly for young people. Most TBI patients have intracerebral hemorrhage, which often to brain edema and toxicity to the neural tissue. Deferoxamine (also known as Deferrioxamine B, Deferoxamine B, DFO-B, DFOA, DFB or desferal,DFX) is a bacterial siderophore produced by the Actinobacteria Streptomyces pilosus. It has medical applications as a chelating agent used to remove excess iron from the body. Animal models indicate Deferoxamine accelerate intracranial hemorrhage absorption, although its effects on human patients remain unclear. In the present study, we investigated whether DFX can accelerate intracranial hemorrhage absorption, reduce acute hemorrhage-induced edema, and improve patient outcome.

    Methods: This is a prospective randomized controlled study. Eighty TBI patients with intracranial hemorrhage that does not require surgical evacuation were recruited. Patients were randomized into Group A or Group B. Patients in Group A were administered DFX 500 mg BID for 7 days, while those in Group B received saline as control. The other therapies were conducted following the severe TBI guideline. The volume of hematomas and levels of brain edema were measured by MR. Follow-up visits were conducted for each patients for 6 months using GOS and MMSE as assessment tools.

    Results: The period of hemorrhage absorption (reduction of 50%) in Group A was approximately 20% faster than those in Group B (p<0.05). The significance of focal edema was also lower in Group A. In the subgroup analysis, patients with subdural hemorrhage and received DFX treatment required 35.7% shorter time of hemorrhage absorption. The 6-month outcomes of patients with DFX treatment were also better than those in Group B. No significant side-effect was observed.

    Conclusions: Based on our preliminary study, DFX offers faster hemorrhage absorption, less significant focal edema, and better outcome for patient with traumatic intracerebral hemorrhage. There is a reason to believe that DFX is effective and safe for traumatic Intracerebral hemorrhage treatment, yet further investigation with more patients are required.

    Patient Care: accelerates hemorrhage absorption for patients with traumatic Intracerebral hematoma with safty using DFX.

    Learning Objectives: Participants should be able to: 1) Describe the importance of brain edema in traumatic Intracerebral hemorrhage: 2) Discuss the application of Deferoxamine in traumatic intracerebral hemorrhage.

    References: 1. Zhao J, Xi G, Wu G, Keep RF, Hua Y.: Deferoxamine Attenuated the Upregulation of Lipocalin-2 Induced by Traumatic Brain Injury in Rats. Acta Neurochir Suppl. 2016;121:291-4. 2.Xie Q, Gu Y, Hua Y, Liu W, Keep RF, Xi G:Deferoxamine attenuates white matter injury in a piglet intracerebral hemorrhage model. Stroke 2014, 45(1):290-292. 3.Yeatts SD, Palesch YY, Moy CS, Selim M: High dosedeferoxamine in intracerebral hemorrhage (HI-DEF)trial: rationale, design, and methods. Neurocrit Care 2013, 19(2):257-266. 4.Lee JY, Keep RF, Hua Y, Ernestus RI, Xi G: Deferoxamine reduces early brain injury following subarachnoid hemorrhage. Acta Neurochir Suppl 2011, 112:101-106. 5.Selim M, Yeatts S, Goldstein JN, Gomes J, Greenberg S, Morgenstern LB, Schlaug G, Torbey M, Waldman B, Xi G et al: Safety and tolerability of deferoxamine mesylate in patients with acute intracerebral hemorrhage. Stroke 2011, 42(11):3067 -3074. 6.Nisenbaum EJ, Novikov DS, Lui YW: The presence and role of iron in mild traumatic brain injury: an imaging perspective. J Neurotrauma 2014, 31(4):301-307. 7. Zhao J, Chen Z, Xi G, Keep RF, Hua Y.: Deferoxamine attenuates acute hydrocephalus after traumatic brain injury in rats. Transl Stroke Res. 2014 Oct;5(5):586-94.

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