Efficacy and safety of prophylactic use of nimodipine in patients with aneurysmal subarachnoid hemorrhage: A meta-analysis
10.3969/j.issn.1672-5921.2011.02.004
- Author:
Guang-Jian LIU
1
Author Information
1. Department of Neurology
- Publication Type:Journal Article
- Keywords:
Intracranial;
Meta-analysis;
Nimodipine;
Randomized controlled trials;
Subarachnoid hemorrhage;
Vasospasm
- From:
Chinese Journal of Cerebrovascular Diseases
2011;8(2):70-76
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the efficacy and safety of nimodipine for cerebral vasospasm (CVS) in patients with aneurysmal subarachnoid hemorrhage. Methods: The database of searched Pubmed, OVID, EMBase, Cochrane library, Stroke Trials Register (U. S. Clinical Trials Registry) , and the National Science and Technology Library up to November 2010 were reviewed. The prospective, randomized, controlled clinical trials about preventive application of nimodipine in patients with aneurysmal subarachnoid hemorrhage controlled clinical trials was collected. Meta-analysis was performed for the studies met the inclusion criteria. Results: Circled digit oneEight studies met the inclusion criteria. A total of 1499 patients completed the trials and observations of the different indicators respectively. In all the patients, the complete recovery rate increased 64% in the nimodipine group compared to the placebo group (P = 0.0002, OR = 1.64, 95% CI 1.26-2.13; the number of patients needed to treat [NNT] = -1.048). The patients with complete recovery or moderate disability increased 79% (P = 0.0007, OR = 1.79, 95% CI 1.28-2.51; NNT = -5.889); the rates of death, severe disability or vegetative survival decreased 38% (P = 0.0003, OR = 0.62, 95% CI 0.48-0.80; NNT = 1.529); the mortality of the patients with CVS decreased 74% (P = 0.008, OR = 0.26, 95% CI 0.09-0.71; NNT = 2.29%); the incidence of symptomatic CVS decreased 46% (P < 0.00001, OR = 0.54, 95% CI 0.42-0.69; NNT = 1.952); the incidence of delayed neurological deficits in all patients decreased 38% (P < 0.0001, OR = 0.62, 95% CI 0.50-0.78; NNT = 1.078); the incidence of symptomatic cerebral infarction decreased 46% (P < 0.00001, OR = 0.54, 95% CI 0.42-0.69; NNT = 1.079); the incidence of cerebral infarction confirmed by CT was 58% of the placebo group (P < 0.001, OR = 0.58, 95% CI 0.42-0.81; NNT = 3.314); the incidence of cerebral infarction in patients with CVS was 35% of the placebo group (P = 0.003, OR = 0.35, 95% CI 0.17-0.69; NNT = 3.688), and the incidence of cerebral infarction in all the patients was only 52% of the placebo group (P < 0.00001, OR = 0.52, 95% CI 0.41-0.66; NNT = 1.196); and there were no significant differences for the incidences of rehemorrhage and adverse reaction between the nimodipine group and the placebo group (rehemorrhage: P = 0.15, OR = 0.75, 95% CI 0.50-1.11; adverse reaction; P = 0.59, OR = 1.13, 95% CI 0.71 -1.81). Conclusion: Nimodipine may significantly improve the clinical outcome in patients with aneurysmal subarachnoid hemorrhage, and decrease the incidence of symptomatic CVS, delayed neurological deficits and cerebral infarction, while the incidence of rehemorrhage and adverse reaction were almost the same with the placebo group.
