Effect of Progesterone Therapy In Traumatic Subarachinoid Haemorrhage On Clinical Outcome, Resistive Vascular Indices of Middle Cerebral Artery Transcranial Doppler And Thromboelastometry. A Promising Layout.

Abstract

Rationale . Recent evidence questions for a safe approach to resuscitate population with traumatic sub-arachinoid hemorrhage (tSAH). Progesterone neuro-protective actions are a matter of debate among literatures. This was the epitome of the current research. Primary outcome was to investigate progesterone actions on cerebral blood flow velocimetry using trans-cranial doppler and on visco-elastic properties of the coagulation and fibrinolytic system by rotational thrombo-elastometry (ROTEM) scanning. Secondary outcome were tracking mortality rate and length of ICU stay. Methods. The current research was a prospective, randomized, double-blind, placebo controlled mono-centeric study. Three hundred thirty two (332) adult patients of both sexes aged 25–60 years, recruited with solo tSAH (no other intra- axial lesions) admitted to Minia university hospital, neuro-critical care floor one. Exclusion criteria included poly-trauma patients (accompanying bone fractures or surgical abdomen), Glasgow coma scale less than 8, red blood cell transfusion during the first 6 hours after admission, hematochrit value > 50%, history of deep venous thrombosis. Two groups were designed, Control group and Progesterone (PR) group. PR group received 100 mg (2ml) intramuscular seven days once daily from hospital admission, while Control group received intramuscular isotonic saline (2ml) daily for seven days as a placebo. Trans-cranial doppler was performed on admission, two days and seven days post-admission. ROTEM exploited on admission and seven days after admission.ResultsProgesterone ameliorated hyperfibrinolysis ( prolong LYS 30 min.) of ROTEM scanning but no other impact on other parameters. Progesterone statistically dampened resistive vascular indices namely pulsatality index (P value =0.001, 0.003) and resistive index (P value=0.001,0.003) but no effect on mean flow velocity of bilateral middle cerebral artery scanning, Progesterone also shortened ICU stay. Conclusions.Progesterone can offer neuronal protection in patients with tSAH by impeding over-fibrinolytic activation .Registration number. (NCT04426487) on clinical trial.gov.Date of registration. Eight of June 2020. Institutional review board. (625/4-2020).