Göttsche Jennifer, Schweingruber Nils, Groth Julian Christopher, Gerloff Christian, Westphal Manfred, Czorlich Patrick
Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany.
Department of Neurology, Hamburg University Medical Center, Hamburg, Germany.
Front Neurol. 2021 Nov 16;12:748413. doi: 10.3389/fneur.2021.748413. eCollection 2021.
Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy. Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to < 0.05. A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch. Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.
多项指南推荐口服尼莫地平以预防动脉瘤性蛛网膜下腔出血（SAH）后的血管痉挛。然而，在临床实践中，根据临床情况和当地治疗方案，该药物采用口服和静脉注射（i.v.）两种给药方式。因此，我们研究了从静脉注射改为口服尼莫地平治疗的安全性和临床效果。本回顾性研究纳入了2014年1月至2018年4月期间患有动脉瘤性SAH且最初接受静脉注射尼莫地平治疗、随后改为口服给药的患者。每天对前循环血管进行经颅多普勒超声（TCD）检查。记录治疗全过程中血管痉挛和梗死的发生情况。统计学显著性水平设定为<0.05。共有133例患者（平均年龄55.8岁，65%为女性）在动脉瘤性SAH后最初接受静脉注射尼莫地平治疗，平均12天后改为口服给药。从静脉注射改为口服尼莫地平给药后，大脑前动脉TCD平均流速没有显著增加。对于大脑中动脉，仅在梗死患者亚组中检测到流速从62.36 cm/秒增加到71.78 cm/秒。在转换期间或之后，没有出现新发血管痉挛或梗死等并发症的聚集现象。我们的结果表明，将尼莫地平从最初的静脉注射改为口服给药不存在任何安全问题。转换既未导致TCD流速出现临床相关增加，也未引发其他相关不良事件。
