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Evidence summaries

Calcium Antagonists for Aneurysmal Subarachnoid Haemorrhage

Calcium antagonists in the form of oral nimodipine reduce the risk of poor outcome after aneurysmal subarachnoid haemorrhage. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 16 studies with a total of 3 361 subjects. Three of the studies were of magnesium sulphate in addition to nimodipine. Overall, calcium antagonists reduced the risk of poor outcome defined as death or dependency in activities of daily life (RR 0.81, 95% CI 0.72 to 0.92; 9 studies, n= 2 589); the corresponding number of patients needed to treat was 19 (95% CI 1 to 51). For oral nimodipine alone the RR was 0.67 (95% CI 0.55 to 0.81, 4 studies, n=853), for other calcium antagonists (nicardipine and AT877) or intravenous administration of nimodipine the results were not statistically significant. Calcium antagonists reduced the occurrence of secondary ischaemia (RR 0.66, 95% CI 0.59 to 0.75; 11 studies, n=2 303) and showed a favourable trend for case fatality (RR 0.87, 95% CI 0.73 to 1.02; 11 studies, n=2 775). For magnesium in addition to standard treatment with nimodipine (3 studies, n=379), the RR was 0.75 (95% CI 0.57 to 1.00) for a poor outcome and 0.66 (95% CI 0.45 to 0.96) for clinical signs of secondary ischaemia.

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    References

    • Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, van Gijn J. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2007 Jul 18;(3):CD000277. [PubMed]

Primary/Secondary Keywords