Iran: Effective Medications for Aneurysmal Subarachnoid Hemorrhage

Cilostazol and Nimodipine are probably the most effective medications for avoiding morbidity and death in individuals suffering from aneurysmal subarachnoid hemorrhage, says an article published in Stroke Journal.

Aneurysmal subarachnoid hemorrhage (aSAH) has a significant mortality and morbidity rate. As a result, Mojtaba Dayyani and colleagues conducted a network meta-analysis of randomized trials to identify the relative advantages of pharmacological preventative therapies in patients with aneurysmal subarachnoid hemorrhage.

This study was searched in Medline, Embase, Web of Science, ProQuest, Scopus, and Cochrane Central up to February 2020. Pairs of reviewers selected relevant studies, extracted data, and assessed the likelihood of bias separately. In adult hospitalized patients with proven aneurysmal subarachnoid hemorrhage, eligible studies assessed the preventive effects of any oral or intravenous drugs or intracranial drug-eluting implants versus one another, placebo, or standard of care. To assess the certainty of the evidence, the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) technique was utilized.

Key Findings

• There were 53 studies with a total of 10,415 people enrolled.
• When compared to a placebo, nimodipine is expected to lower all-cause mortality.
• At the longest follow-up, nimodipine and cilostazol were the most effective therapies for improving impairment.
• Clazosentan, fasudil, nicardipine, and magnesium were shown to be the most effective in lowering the chance of delayed cerebral ischemia when compared to placebo.

The authors found that Clazosentan, nicardipine, fasudil, and magnesium showed beneficial effects on delayed cerebral ischemia and vasospasm. Future trials are needed to elaborately investigate the prophylactic effects of medications such as cilostazol and clazosentan, that can improve mortality and long-term functional outcomes.

Reference

Dayyani, M., Sadeghirad, B., Grotta, J. C., Zabihyan, S., Ahmadvand, S., Wang, Y., Guyatt, G. H., & Amin-Hanjani, S. (2022). Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials. In Stroke. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/strokeaha.121.035699