scholarly journals Corticosteroids in the Management of Hyponatremia, Hypovolemia, and Vasospasm in Subarachnoid Hemorrhage: A Meta-Analysis

2016 ◽  
Vol 42 (3-4) ◽  
pp. 263-271 ◽  
Author(s):  
Akshitkumar M. Mistry ◽  
Eva A. Mistry ◽  
Nishant Ganesh Kumar ◽  
Michael T. Froehler ◽  
Matthew R. Fusco ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Patient Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Significant Morbidity ◽  
Corticosteroid Administration ◽  
Symptomatic Vasospasm ◽  
Meta Analyses ◽  
Mineralocorticoid Activity

Background: Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality. Studies have shown the benefit of corticosteroids in the management of these sequelae. We have reviewed the literature and analyzed the available data for corticosteroid use after SAH. Methods: PubMed, EMBASE, and Cochrane electronic databases were searched without language restrictions, and 7 observational, controlled clinical studies of the effect of corticosteroids in the management of SAH patients were identified. Data on sodium and fluid balances, symptomatic vasospasm (SVS), and outcomes were pooled for meta-analyses using the Mantel-Haenszel random effects model. Results: Corticosteroids, specifically hydrocortisone and fludrocortisone, decreased natriuretic diuresis and incidence of hypovolemia. Corticosteroid administration is associated with lower incidence of SVS in the absence of nimodipine, but does not alter the neurological outcome. Conclusions: Supplementation of corticosteroids with mineralocorticoid activity, such as hydrocortisone or fludrocortisone, helps in maintaining sodium and volume homeostasis in SAH patients. Larger trials are warranted to confirm the effects of corticosteroids on SVS and patient outcomes.

Interleukin-1 and Interleukin-6 Polymorphisms Might Influence Predisposition to Hemorrhagic Cerebral Vascular Diseases: A Meta-Analysis

2021 ◽  
pp. 1-7
Author(s):  
Jianjian Lin ◽  
Weiqiao Zhang ◽  
Zhengzhong Wang ◽  
Fei Zhao
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Interleukin 6 ◽  
Web Of Science ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Interleukin 1 ◽  
Vascular Diseases ◽  
Meta Analyses ◽  
The Relationship ◽  
Cerebral Vascular

<b><i>Background:</i></b> Interleukin-1 (<i>IL-1</i>) and <i>IL-6</i> polymorphisms might influence predisposition to hemorrhagic cerebral vascular diseases, but the results of already published studies regarding relationship between <i>IL-1/IL-6</i> polymorphisms and hemorrhagic cerebral vascular diseases were still controversial and ambiguous. <b><i>Objectives:</i></b> The authors designed this meta-analysis to more precisely estimate the relationship between <i>IL-1/IL-6</i> polymorphisms and hemorrhagic cerebral vascular diseases by pooling the results of already published related studies. <b><i>Methods:</i></b> The authors searched PubMed, EMBASE, Web of Science, and CNKI for already published studies. Eighteen already published studies were pooled analyzed in this meta-analysis. <b><i>Results:</i></b> The pooled meta-analyses’ results showed that distributions of <i>IL-1A</i> rs1800587, <i>IL-1B</i> rs16944, and <i>IL-6</i> rs1800796 polymorphisms among patients and controls differed significantly. Moreover, distribution of the <i>IL-6</i> rs1800795 polymorphism among patients and controls from Asians also differed significantly. Further analyses showed similar findings for <i>IL-1A</i> rs1800587, <i>IL-1B</i> rs16944, and <i>IL-6</i> rs1800796 polymorphisms in aneurysmal subarachnoid hemorrhage (aSAH) subgroup. <b><i>Conclusions:</i></b> This meta-analysis suggested that <i>IL-1A</i> rs1800587, <i>IL-1B</i> rs16944, and <i>IL-6</i> rs1800796 polymorphisms might influence susceptibility to hemorrhagic cerebral vascular diseases, especially for aSAH. Moreover, <i>IL-6</i> rs1800795 might influence susceptibility to hemorrhagic cerebral vascular diseases in Asians.

scholarly journals Continous local Intra –arterial Nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage:a meta-analysis

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A N Elshaer ◽  
I S Habil ◽  
A A Moharram ◽  
M A Menshawe ◽  
A M Marzouk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Neurological Deficit ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Channel Blockers ◽  
Oral Calcium ◽  
Symptomatic Vasospasm ◽  
Conscious Level ◽  
Triple H

Abstract Background Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space (the area between the arachnoid membrane and the pia mater surrounding the brain). SAH is a potentially life threatening condition. Hemorrhage may occur as a result of a head injury or spontaneously (usually from a ruptured cerebral aneurysm). Spontaneous subarachnoid hemorrhage occurs in about one per 10,000 people per year. Females are more commonly affected than males. While it becomes more common with age, about 50% of people present under 55 years old. It is a form of stroke and comprises about 5 % of all strokes. Disturbed conscious level, specially that associated with cerebral arterial vasospasm, remains a major cause of death and disability in the patients with aneurysmal subarachnoid hemorrhage.The classical modality of management for vasospasm was oral calcium channel blockers (nimodipine) with triple-H therapy (Hypedynamic augmentation therapy). Aim To evaluate the effect of Continous local Intra –arterial nimodipine administration in severe symptomatic vasospasm after spontanous subarachnoid hemorrhage on mortality and morbidity (symptomtic cerebral ischemia). Methodology: Studies and participants In the current meta-analysis, we searched for interventional clinical trials in critically ill adult patients that evaluated to have aneurysmal subarachnoid hemorrhage complicated by severe symptomatic vasospasm (causing delayed cerebral ischemia and neurological deficits) which was refractory to standard hyper dynamic therapy (triple- H therapy) and oral calcium channel blockers (CCBS). Results In the current meta-analysis, the duration of infusion of nimodipine was at least for 72 hours. The onset of occurance of cerebral vasodilation after the infusion in all studies by their different doses was 12 hours detected by transcranial doppler. The time of termination of nimodipine infusion is different from patient to other patient depending on clinical improvement ( improvement of consious level or disappearance of the newly developed neurological deficit) and radiological findings that refers to the relief of vasospasm assesed by transcranial doppler and cerebral angiography. Reinfusion of the nimodipine was done in all included studies in case of recurrence of vasospasm causing new neurological deficit or deterioration in the conscious level . Conclusion It concluded from the current meta-analysis that, intra-arterial nimodipine infusion is effective and safe treatment for syptomatic refractory vasospasm after aneurysmal subarachnoid hemorrhage.

Abstract TMP21: Cilostazol for Prevention of Cerebral Vasospasm and Cerebral Ischemia in Patients With Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis of Randomized Controlled Clinical Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Iryna Lobanova ◽  
Kathryn Qualls ◽  
Renee L Martin ◽  
Niraj Arora ◽  
Premkumar Nattanmai ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Phase Iii ◽  
Controlled Clinical Trials ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Symptomatic Vasospasm

Introduction: Cilostazol, a selective inhibitor of phosphodiesterase 3, may reduce symptomatic vasospasm and associated cerebral ischemia and improve outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH) due to its anti-platelet, anti-proliferative, and vasodilatory effects. Due to recent publication of randomized controlled clinical trials, a meta-analysis was performed to identify the common treatment effect. Methods: We performed a meta-analysis of four randomized controlled clinical trials. The primary endpoint of interest was cerebral ischemia related to vasospasm. Secondary endpoints were angiographic vasospasm, new cerebral infarct, mortality, and death or disability at the 90 days following randomization. Using random-effects models with study as a random effect, relative risks (RR) and 95% confidence intervals (CI) were generated Results: A total of 405 subjects (200 randomized to oral cilostazol 100 mg twice per day) were included in the meta-analysis. The proportion of subjects with cerebral ischemia related to vasospasm was significantly lower in those who were assigned to cilostazol treatment (RR 0.46; 95% CI 0.21-1.00; p< 0.050) without any heterogeneity between the trials (Cochran’s Q statistic 1.52, df 2; P = .468, I 2 =0.0%). The proportion of subjects who had new cerebral infarction was significantly lower in subjects who were assigned to cilostazol treatment (RR 0.40, 95% CI 0.32-0.49, p=0.0009). There was a lower rate of death or disability at 90 days in subjects who were assigned to cilostazol treatment (RR 0.44, 95% 0.28-0.70, p=0.011) without any heterogeneity between the trials (Cochran’s Q statistics 1.49, df 3; P = .685, I 2 =0.0%). The proportion of subjects who had any adverse events was not significantly different in subjects who were assigned to cilostazol treatment (RR 1.24, 95% 0.68-2.25, p=0.26). Conclusion: The reduction in rates of cerebral ischemia related to vasospasm and death or disability at follow-up support further evaluation of oral cilostazol in patients with aSAH in a phase III large randomized clinical trial.

Antiplatelet therapy and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
M. Harrison Snyder ◽  
Natasha Ironside ◽  
Jeyan S. Kumar ◽  
Kevin T. Doan ◽  
Ryan T. Kellogg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Antiplatelet Therapy ◽  
Subgroup Analysis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Delayed Cerebral Ischemia ◽  
Symptomatic Vasospasm ◽  
Increased Risk

OBJECTIVE Delayed cerebral ischemia (DCI) is a potentially preventable cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The authors performed a meta-analysis to assess the effect of antiplatelet therapy (APT) on DCI in patients with aSAH. METHODS A systematic review of the PubMed and MEDLINE databases was performed. Study inclusion criteria were 1) ≥ 5 aSAH patients; 2) direct comparison between aSAH management with APT and without APT; and 3) reporting of DCI, angiographic, or symptomatic vasospasm rates for patients treated with versus without APT. The primary efficacy outcome was DCI. The outcomes of the APT versus no-APT cohorts were compared. Bias was assessed using the Downs and Black checklist. RESULTS The overall cohort comprised 2039 patients from 15 studies. DCI occurred less commonly in the APT compared with the no-APT cohort (pooled = 15.9% vs 28.6%; OR 0.47, p < 0.01). Angiographic (pooled = 51.6% vs 68.7%; OR 0.46, p < 0.01) and symptomatic (pooled = 23.6% vs 37.7%; OR 0.51, p = 0.01) vasospasm rates were lower in the APT cohort. In-hospital mortality (pooled = 1.7% vs 4.1%; OR 0.53, p = 0.01) and functional dependence (pooled = 21.0% vs 35.7%; OR 0.53, p < 0.01) rates were also lower in the APT cohort. Bleeding event rates were comparable between the two cohorts. Subgroup analysis of cilostazol monotherapy compared with no APT demonstrated a lower DCI rate in the cilostazol cohort (pooled = 10.6% vs 28.1%; OR 0.31, p < 0.01). Subgroup analysis of surgically treated aneurysms demonstrated a lower DCI rate for the APT cohort (pooled = 18.4% vs 33.9%; OR 0.43, p = 0.02). CONCLUSIONS APT is associated with improved outcomes in aSAH without an increased risk of bleeding events, particularly in patients who underwent surgical aneurysm repair and those treated with cilostazol. Although study heterogeneity is the most significant limitation of the analysis, the findings suggest that APT is worth exploring in patients with aSAH, particularly in a randomized controlled trial setting.

Early identification of patients at risk for symptomatic vasospasm after aneurysmal subarachnoid hemorrhage

2000 ◽  
Vol 28 (4) ◽  
pp. 984-990 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Gene Y. Sung ◽  
Alexander Y. Razumovsky ◽  
Karen Lane ◽  
Robert N. Straw ◽  
...  
Keyword(s):  
At Risk ◽  
Subarachnoid Hemorrhage ◽  
Early Identification ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Symptomatic Vasospasm ◽  
Patients At Risk
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