Calcium antagonists in patients with subarachnoid hemorrhage (SAH): a meta-analysis

Tags: Poster
Feigin V, Rinkel G, Algra A, Vermeulen M, van Gijn J

Introduction: It has been reported that calcium antagonist drugs reduce the frequency of delayed cerebral ischaemia (DCI) and improve outcome after aneurysmal SAH, but definitive evidence is lacking.

Objective: To determine whether calcium antagonists improve outcome and reduce the incidence of DCI in patients with aneurysmal SAH.

Methods: Systematic overview of unconfounded, randomized trials that were completed by January 1996 comparing calcium antagonists with control started within 10 days of SAH onset.

Results: Nine trials met all the inclusion criteria. Overall, calcium antagonists produced a highly significant reduction in the odds of ischemic related poor outcome (OR 0.57; 95% CI 0.44-0.74) and mortality (OR 0.53; 95% CI 0.37-0.76) and DCI (OR 0.58; 95% CI 0.50-0.67) within three months after SAH. In the analysis for only nimodipine, treatment was associated with a highly significant 45% reduction in the odds of poor outcome from all causes (OR 0.57; 95% CI 0.43-0.76). A strong, but statistically insignificant, tendency towards reducing the incidence of rebleeding episodes among patients allocated to calcium antagonist treatment was found (OR 0.77; 95% CI 0.56-1.05). Unlike nicardipine and AT877, nimodipine did not significantly reduce the incidence of angiographically detected cerebral vasospasm (OR 0.60; 95% CI 0.32-1.12).

Discussion: Calcium antagonist drugs reduce ischemic related poor outcome at three months after aneurysmal SAH. Nimodipine improves overall outcome within three months of SAH. The evidence for a reduction of poor outcome from all causes by nicardipine and AT877 is inconclusive.