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Calcium antagonists for aneurysmal subarachnoid haemorrhage
G J Rinkel1, V L Feigin, 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
|January 10, 2003
Summary
Calcium antagonists significantly reduce poor outcomes and neurological deficits in patients with subarachnoid hemorrhage (SAH). Oral nimodipine is indicated, though further research is needed for optimal use and other agents.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Secondary ischemia frequently impacts outcomes in subarachnoid hemorrhage (SAH) patients.
- Vasospasm is a potential cause, and calcium antagonists may prevent or reverse it.
- Existing trial data on calcium antagonists for SAH are conflicting.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists in improving outcomes for patients with aneurysmal subarachnoid hemorrhage (SAH).
Main Methods:
- Systematic review of completed, unconfounded, randomized controlled trials (RCTs) of calcium antagonists within 10 days of SAH onset.
- Searched Cochrane Stroke Group Trials Register and handsearched Russian journals; contacted trialists and pharmaceutical companies.
- Eleven RCTs involving 2804 patients (nimodipine, nicardipine, AT877) were included.
Main Results:
- Calcium antagonists significantly reduced the risk of poor outcome (RR 0.82) and ischemic neurological deficits (RR 0.67) after SAH.
- Oral nimodipine showed a significant reduction in poor outcome (RR 0.69).
- No significant reduction in mortality was observed (RR 0.94), but CT-documented cerebral infarction risk decreased (RR 0.80).
Conclusions:
- Calcium antagonists, particularly oral nimodipine, improve outcomes and reduce neurological deficits in aneurysmal SAH patients.
- Oral nimodipine is indicated despite some uncertainties; intravenous administration is not recommended.
- Further research is needed on optimal dosing, patient selection, and comparative efficacy of different calcium antagonists.