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Evidence summaries

Calcium Antagonists for Stroke

Calcium antagonists appear not to be beneficial for patients with acute ischaemic stroke. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 34 studies with a total of 7731 subjects with acute ischaemic stroke. The average age ranging from 52.3 to 74.6 years across trials. Twenty-six trials tested nimodipine, and 3 trials assessed flunarizine. One trial each used isradipine, nicardipine, PY108-608, fasudil, and lifarizine. More than half of these trials followed participants for at least 3 months. Calcium antagonists showed no effects on the primary outcome (RR 1.05; 95% CI 0.98 to 1.13; 22 trials, n=6684) or on death at the end of follow-up (RR 1.07, 95% CI 0.98 to 1.17; 31 trials, n=7483). Thirteen trials reported adverse events, finding no significant differences between groups.

Comment: A quality of evidence is downgraded by publication bias (the published trials showed no effect on primary outcome but unpublished trials were associated with a statistically significantly worse outcome in the treatment group).

References

  • Zhang J, Liu J, Li D et al. Calcium antagonists for acute ischemic stroke. Cochrane Database Syst Rev 2019;2():CD001928. [PubMed]

Primary/Secondary Keywords