Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
World Neurosurg. 2021 Nov;155:41-53. doi: 10.1016/j.wneu.2021.07.104. Epub 2021 Jul 30.
Vasospasm and delayed ischemic neurologic deficits are the leading causes of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Several therapeutic agents have been assessed in randomized controlled trials for their efficacy in reducing the incidence of vasospasm and improving functional outcome. The aim of this network meta-analysis is to compare all these therapeutic agents for their effect on functional outcome and other parameters after aSAH.
A comprehensive search of different databases was performed to retrieve randomized controlled trials describing the effect of various therapeutic approaches on functional outcome and other parameters after aSAH.
Ninety-two articles were selected for full text review and 57 articles were selected for the final analysis. Nicardipine prolonged-release implants were found to be the best treatment in terms of favorable outcome (odds ratio [OR], 8.55; 95% credible interval [CrI], 1.63-56.71), decreasing mortality (OR, 0.08; 95% CrI, 0-0.82), and preventing angiographic vasospasm (OR, 0.018; 95% CrI, 0.00057-0.16). Cilostazol was found to be the second-best treatment in improving favorable outcomes (OR, 3.58; 95% CrI, 1.97-6.57) and decreasing mortality (OR, 0.41; 95% CrI, 0.12-1.15). Fasudil (OR, 0.16; 95% CrI, 0.03-0.78) was found to be the best treatment in decreasing increased vessel velocity and enoxaparin (OR, 0.25; 95% CrI, 0.057-1.0) in preventing delayed ischemic neurologic deficits.
Our analysis showed that nicardipine prolonged-release implants and cilostazol were associated with the best chance of improving favorable outcome and mortality in patients with aSAH. However, larger multicentric studies from other parts of the world are required to confirm these findings.
血管痉挛和迟发性缺血性神经功能缺损是蛛网膜下腔出血（aSAH）后发病率和死亡率的主要原因。已经在随机对照试验中评估了几种治疗药物，以评估其降低血管痉挛发生率和改善功能结局的疗效。本网络荟萃分析的目的是比较所有这些治疗药物对 aSAH 后功能结局和其他参数的影响。
全面检索不同数据库，以检索描述各种治疗方法对 aSAH 后功能结局和其他参数影响的随机对照试验。
选择了 92 篇文章进行全文审查，选择了 57 篇文章进行最终分析。尼卡地平缓释植入物在改善预后（优势比[OR]，8.55；95%可信区间[CrI]，1.63-56.71）、降低死亡率（OR，0.08；95% CrI，0-0.82）和预防血管造影性血管痉挛（OR，0.018；95% CrI，0.00057-0.16）方面被认为是最佳治疗方法。西洛他唑被认为是改善预后（OR，3.58；95% CrI，1.97-6.57）和降低死亡率（OR，0.41；95% CrI，0.12-1.15）的第二佳治疗方法。法舒地尔（OR，0.16；95% CrI，0.03-0.78）在降低血管速度增加方面是最佳治疗方法，依诺肝素（OR，0.25；95% CrI，0.057-1.0）在预防迟发性缺血性神经功能缺损方面是最佳治疗方法。
我们的分析表明，尼卡地平缓释植入物和西洛他唑与改善 aSAH 患者的预后和死亡率的最佳机会相关。然而，需要来自世界其他地区的更大的多中心研究来证实这些发现。
