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Calcium antagonists for aneurysmal subarachnoid haemorrhage
V L Feigin1, G J Rinkel, A Algra
1Department of Neurology, University Hospital Utrecht, PO Box 85500, Utrecht, Netherlands, 3508 GA. g.j.e.rinkel@neuro.azu.nl
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Calcium antagonists significantly reduce poor outcomes and ischemic neurological deficits following subarachnoid hemorrhage (SAH). Nimodipine shows particular benefit, though its exact mechanism remains unclear.
Area of Science:
- Neurology
- Pharmacology
Background:
- Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms can cause cerebral artery spasm and ischemic brain damage.
- Calcium antagonists may offer prophylactic benefits against such ischemic damage.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists in improving patient outcomes after aneurysmal subarachnoid hemorrhage (SAH).
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified through the Cochrane Stroke Group trials register, hand searching, and industry contacts.
- Eleven RCTs involving 2804 patients with SAH were included, comparing calcium antagonists with control groups.
Main Results:
- Calcium antagonists demonstrated a significant reduction in the risk of poor outcome (RR 0.82) and ischemic neurological deficits (RR 0.67) in SAH patients.
- Oral nimodipine specifically showed a significant reduction in poor outcome (RR 0.69).
- No statistically significant reduction in case fatality was observed for calcium antagonists overall.
Conclusions:
- Calcium antagonists are effective in reducing poor outcomes and ischemic neurological deficits post-aneurysmal SAH.
- The benefits are primarily driven by nimodipine, while evidence for nicardipine and AT877 remains inconclusive.
- The precise mechanisms by which nimodipine improves outcomes in SAH require further investigation.