Farshad Nassiri1,2,3,4, George M Ibrahim1,2,3,4, Jetan H Badhiwala1,2,3,4, Christopher D Witiw1,2,3,4, Alireza Mansouri1,2,3,4, Naif M Alotaibi1,2,3,4, R Loch Macdonald5,6,7,8. 1. Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 2. Labatt Family Centre of Excellence in Brain Injury and Trauma Research, St. Michael's Hospital, Toronto, Canada. 3. Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. 4. Department of Surgery, University of Toronto, Toronto, ON, Canada. 5. Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. MacdonaldLo@smh.ca. 6. Labatt Family Centre of Excellence in Brain Injury and Trauma Research, St. Michael's Hospital, Toronto, Canada. MacdonaldLo@smh.ca. 7. Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada. MacdonaldLo@smh.ca. 8. Department of Surgery, University of Toronto, Toronto, ON, Canada. MacdonaldLo@smh.ca.
Abstract
BACKGROUND: Inflammation may contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Here, we compared outcomes among propensity score-matched cohorts who did and did not receive non-steroidal anti-inflammatory drug (NSAID) use after aSAH. METHODS: Propensity score-matched analysis of 413 subjects enrolled in the Clazosentan to Overcome Neurological iSChemia and Infarction OccUring after Subarachnoid hemorrhage (CONSCIOUS-1) study. Propensity score matching was performed on the basis of age, sex, baseline National Institutes of Health Stroke Scale score, World Federation of Neurological Societies grade on admission, procedure used for securing aneurysm, and SAH clot burden. RESULTS:178 patients were matched (89 received NSAIDs, 89 did not). Propensity score matching was considered acceptable. Patients who had received NSAIDs during their hospital stay had significantly lower mortality rate, and reduced duration of intensive care unit stay and total length of hospital stay (P = 0.035, P = 0.009, and P = 0.053, respectively). At 6 weeks, 80.9 % of patients treated with NSAIDs had good functional outcome compared to 68.5 % of matched controls (P = 0.083). There was no significant difference in the proportions of patients who developed delayed ischemic neurological deficits, angiographic vasospasm, or required rescue therapy. CONCLUSIONS: Inflammation may play a crucial role in the poor outcomes after SAH, and that NSAIDs may be a useful therapeutic option, once validated by larger prospective studies.
RCT Entities:
BACKGROUND: Inflammation may contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Here, we compared outcomes among propensity score-matched cohorts who did and did not receive non-steroidal anti-inflammatory drug (NSAID) use after aSAH. METHODS: Propensity score-matched analysis of 413 subjects enrolled in the Clazosentan to Overcome Neurological iSChemia and Infarction OccUring after Subarachnoid hemorrhage (CONSCIOUS-1) study. Propensity score matching was performed on the basis of age, sex, baseline National Institutes of Health Stroke Scale score, World Federation of Neurological Societies grade on admission, procedure used for securing aneurysm, and SAH clot burden. RESULTS: 178 patients were matched (89 received NSAIDs, 89 did not). Propensity score matching was considered acceptable. Patients who had received NSAIDs during their hospital stay had significantly lower mortality rate, and reduced duration of intensive care unit stay and total length of hospital stay (P = 0.035, P = 0.009, and P = 0.053, respectively). At 6 weeks, 80.9 % of patients treated with NSAIDs had good functional outcome compared to 68.5 % of matched controls (P = 0.083). There was no significant difference in the proportions of patients who developed delayed ischemic neurological deficits, angiographic vasospasm, or required rescue therapy. CONCLUSIONS: Inflammation may play a crucial role in the poor outcomes after SAH, and that NSAIDs may be a useful therapeutic option, once validated by larger prospective studies.
Authors: Jan Claassen; David Albers; J Michael Schmidt; Gian Marco De Marchis; Deborah Pugin; Christina Maria Falo; Stephan A Mayer; Serge Cremers; Sachin Agarwal; Mitchell S V Elkind; E Sander Connolly; Vanja Dukic; George Hripcsak; Neeraj Badjatia Journal: Ann Neurol Date: 2014-05-16 Impact factor: 10.422
Authors: Michael K Tso; Paul Turgeon; Bert Bosche; Charles K Lee; Tian Nie; Josephine D'Abbondanza; Jinglu Ai; Philip A Marsden; R Loch Macdonald Journal: Sci Rep Date: 2021-04-09 Impact factor: 4.379
Authors: William S Dodd; Dimitri Laurent; Aaron S Dumont; David M Hasan; Pascal M Jabbour; Robert M Starke; Koji Hosaka; Adam J Polifka; Brian L Hoh; Nohra Chalouhi Journal: J Am Heart Assoc Date: 2021-07-30 Impact factor: 5.501