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The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report

Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-pr...

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Autores principales: Ramadhan, Mochamad Iskandarsyah Agung, Sitanaya, Shierly Novitawati, Hakim, Ariadri Hafian Wulandaru, Ramli, Yetty
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10058021/
https://www.ncbi.nlm.nih.gov/pubmed/36984454
http://dx.doi.org/10.3390/medicina59030453
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author Ramadhan, Mochamad Iskandarsyah Agung
Sitanaya, Shierly Novitawati
Hakim, Ariadri Hafian Wulandaru
Ramli, Yetty
author_facet Ramadhan, Mochamad Iskandarsyah Agung
Sitanaya, Shierly Novitawati
Hakim, Ariadri Hafian Wulandaru
Ramli, Yetty
author_sort Ramadhan, Mochamad Iskandarsyah Agung
collection PubMed
description Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-products of lysing clots in ICH might contribute to this secondary injury by triggering perihematomal edema. We present a clinical situation of an ICH case where iron-chelating therapy might be beneficial, as supported by scientific evidence. We looked through four databases (Pubmed, Cochrane, Embase, and Google Scholar) to find studies assessing the efficacy of iron-chelating therapy in ICH patients. Validity, importance, and applicability (VIA) of the included articles were appraised using worksheets from the Oxford Centre for Evidence-Based Medicine. Two out of five eligible studies were valid, important, and applicable to our patient. Both studies showed the positive effects of iron-chelating therapy on neurological outcome, as measured by National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS). The beneficial effects of deferoxamine were demonstrated within the moderate volume (10–30 mL) subgroup, with a positive relative risk reduction (RRR) and low number needed to treat (six persons). Based on our appraisal, we considered iron-chelating therapy as an additional therapy for ICH patients, given its benefits and adverse effects. More specific studies using a larger sample size, focusing on moderate-volume ICH, and using standardized neurological outcomes are encouraged.
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spelling pubmed-100580212023-03-30 The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report Ramadhan, Mochamad Iskandarsyah Agung Sitanaya, Shierly Novitawati Hakim, Ariadri Hafian Wulandaru Ramli, Yetty Medicina (Kaunas) Case Report Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-products of lysing clots in ICH might contribute to this secondary injury by triggering perihematomal edema. We present a clinical situation of an ICH case where iron-chelating therapy might be beneficial, as supported by scientific evidence. We looked through four databases (Pubmed, Cochrane, Embase, and Google Scholar) to find studies assessing the efficacy of iron-chelating therapy in ICH patients. Validity, importance, and applicability (VIA) of the included articles were appraised using worksheets from the Oxford Centre for Evidence-Based Medicine. Two out of five eligible studies were valid, important, and applicable to our patient. Both studies showed the positive effects of iron-chelating therapy on neurological outcome, as measured by National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS). The beneficial effects of deferoxamine were demonstrated within the moderate volume (10–30 mL) subgroup, with a positive relative risk reduction (RRR) and low number needed to treat (six persons). Based on our appraisal, we considered iron-chelating therapy as an additional therapy for ICH patients, given its benefits and adverse effects. More specific studies using a larger sample size, focusing on moderate-volume ICH, and using standardized neurological outcomes are encouraged. MDPI 2023-02-24 /pmc/articles/PMC10058021/ /pubmed/36984454 http://dx.doi.org/10.3390/medicina59030453 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Ramadhan, Mochamad Iskandarsyah Agung
Sitanaya, Shierly Novitawati
Hakim, Ariadri Hafian Wulandaru
Ramli, Yetty
The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title_full The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title_fullStr The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title_full_unstemmed The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title_short The Role of Iron-Chelating Therapy in Improving Neurological Outcome in Patients with Intracerebral Hemorrhage: Evidence-Based Case Report
title_sort role of iron-chelating therapy in improving neurological outcome in patients with intracerebral hemorrhage: evidence-based case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10058021/
https://www.ncbi.nlm.nih.gov/pubmed/36984454
http://dx.doi.org/10.3390/medicina59030453
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