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Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis
Sanne M Dorhout Mees1, Ale Algra1, George K C Wong1
1From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Division of Neurosurgery, Department of Critical Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China (G.K.C.W., W.S.P.); Department of Critical Care, Royal North Shore Hospital, Sydney, Australia (C.M.B.); Department of Neurology (J.L.S.) and Departments of Emergency Medicine and Neurology (S.S.), Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles; and Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (W.M.v.d.B.).
Early magnesium treatment after subarachnoid hemorrhage (SAH) did not improve outcomes or reduce delayed cerebral ischemia (DCI). This meta-analysis found no evidence to support further trials of early magnesium for SAH patients.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Trials
Background:
- Delayed cerebral ischemia (DCI) is a significant complication following aneurysmal subarachnoid hemorrhage (SAH).
- Previous trials of magnesium treatment initiated later than 4 days after SAH onset showed no benefit.
- The potential efficacy of early magnesium administration remains uncertain due to insufficient statistical power in individual studies.
Purpose of the Study:
- To investigate the effectiveness of magnesium treatment when initiated within 24 hours after SAH onset.
- To analyze magnesium's impact on poor outcome and DCI across different early treatment time frames.
Main Methods:
- An individual patient data meta-analysis was conducted.
- Patients were categorized based on the time to magnesium treatment initiation: <6 hours, 6-12 hours, 12-24 hours, and >24 hours.
- Adjusted risk ratios and 95% confidence intervals were calculated for magnesium versus placebo.
Main Results:
- The analysis included 1981 patients from 5 trials, with 83 starting treatment <6 hours.
- Magnesium treatment showed no significant benefit for poor outcome across all time frames (<6h: RR 1.44, 6-12h: RR 1.03, 12-24h: RR 0.84, >24h: RR 1.06).
- Similarly, magnesium did not significantly reduce DCI ( <6h: RR 1.76, 6-12h: RR 2.09, 12-24h: RR 0.80, >24h: RR 1.08).
Conclusions:
- This meta-analysis indicates that early magnesium treatment does not improve outcomes or reduce DCI in SAH patients.
- Despite a small number of patients in the earliest treatment group, no definitive beneficial effect was observed.
- The findings do not support initiating new clinical trials for early magnesium treatment in SAH.
