While corticosteroid use in Acute Hemorrhagic Stroke (AHS) is not widely adopted, management with intravenous dexamethasone (IVDxM) has been standard of care at the University Hospital of Heraklion, Crete (UH-Crete) with observed outcomes superior to those reported in literature. To explore this further, we conducted a retrospective, multivariable-adjusted two-center study.
We studied 391 AHS cases admitted to UH-Crete between 1/1997 and 7/2010 and compared them with 510 AHS cases admitted to Massachusetts General Hospital, Boston from 1/2003 to 9/2009. Of the Cretan cases, 340 received a tapering scheme of IVDxM, starting with 16–32 mg/day, while the Boston patients were managed without steroids.
The two cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0 %, n=510; p<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510; p<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359; p<0.001). The improved survival on Crete was observed three days after initiation of IVDxM and was pronounced for deep-seated hemorrhages. After adjusting for AHS volume/location, GCS, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet and anticoagulant use, IVDxM treatment was associated with better functional outcomes and significantly lower risk of death at 30-days (odds ratio 0.357; 95% C.I. 0.174–0.732).
This study suggests that IVDxM improves outcome in AHS and supports a randomized clinical trial using this approach.