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Calcium antagonists for aneurysmal subarachnoid haemorrhage
G J E 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 28, 2005
Summary
Calcium antagonists, particularly oral nimodipine, significantly reduce poor outcomes and secondary ischemia in patients with subarachnoid hemorrhage (SAH). While evidence for other calcium antagonists is inconclusive, oral nimodipine is recommended for SAH treatment.
Area of Science:
- Neurology
- Pharmacology
Background:
- Secondary ischemia is a common complication following subarachnoid hemorrhage (SAH), often leading to poor patient outcomes.
- The exact pathogenesis of secondary ischemia remains unclear but is potentially linked to vasospasm.
- Calcium antagonists have demonstrated potential in preventing vasospasm and exhibiting neuroprotective effects, prompting investigation in clinical trials.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists in improving outcomes for patients diagnosed with aneurysmal subarachnoid hemorrhage (SAH).
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted, searching major databases (Cochrane Stroke Group, MEDLINE, EMBASE) and contacting trialists.
- Twelve RCTs involving 2844 patients with SAH were analyzed.
- Data extraction and quality assessment were performed independently by two reviewers.
Main Results:
- Calcium antagonists, as a group, reduced the risk of poor outcome (RR 0.82, 95% CI 0.72 to 0.93), with an absolute risk reduction of 5.1%.
- Oral nimodipine showed a significant reduction in poor outcome (RR 0.70, 0.58 to 0.84).
- Calcium antagonists also decreased the risk of clinical signs of secondary ischemia (RR 0.67, 0.60 to 0.76) and confirmed infarction (RR 0.80, 0.71 to 0.89).
Conclusions:
- Calcium antagonists are effective in reducing poor outcomes and secondary ischemia after aneurysmal SAH.
- Oral nimodipine (60 mg every 4 hours) is indicated for patients with aneurysmal SAH due to demonstrated benefits, despite some uncertainty in the evidence.
- Intravenous administration of calcium antagonists is not recommended for routine practice based on current evidence.