A Cochrane review [Abstract] 1 included 4 studies with a total of 2024 subjects with subarachnoidal haemorrhage. The trials compared endothelin receptor antagonists (ETA, clazosentan in 3 trials and investigational product TAK-044 in one trial) with placebo over 10 to 14 days. ETAs reduced the incidence of delayed ischemic neurological deficit (DIND) (RR 0.80; 95% CI 0.67 to 0.95; 3 studies, n=1976) and angiographic vasospasm (RR 0.62; 95% CI 0.52 to 0.72; 3 studies, n=1588). However, it did not reduce the incidence of unfavorable outcomes (RR 0.87; 95% CI 0.74 to 1.02; 3 studies, n=1976) or mortality (RR 1.05; 95% CI 0.77 to 1.45; 4 studies, n=2024). ETAs increased the incidence of hypotension (RR 2.53; 95% CI 1.77 to 3.62; 4 studies, n=2024) and pneumonia (RR 1.56; 95% CI 1.23 to 1.97; 3 studies, n=1976).
Comment: The quality of the evidence is downgraded by indirectness (differences in outcomes).
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