Jennifer D Sokolowski1, Ching-Jen Chen2, Sauson Soldozy3, Panagiotis Mastorakos4, Rebecca M Burke5, Julia M Nguyen6, Kristin M Myers7, M Yashar S Kalani8, Min S Park9. 1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States. Electronic address: soko@virginia.edu. 2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States. Electronic address: Cc5hx@virginia.edu. 3. School of Medicine, University of Virginia, Charlottesville, VA, United States. Electronic address: Ss2ah@virginia.edu. 4. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States; Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, United States. Electronic address: Pm5mt@virginia.edu. 5. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States. Electronic address: Rmb8as@virginia.edu. 6. University of Virginia, Charlottesville, VA, United States. Electronic address: Jmn7yf@virginia.edu. 7. University of Virginia, Charlottesville, VA, United States. Electronic address: Kmm8jc@virginia.edu. 8. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States. Electronic address: Stemcelldoctor@gmail.com. 9. Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States. Electronic address: Mp2tq@virginia.edu.
Abstract
BACKGROUND: Randomized-controlled trials and meta-analyses showed nimodipine use after aneurysmal subarachnoid hemorrhage (aSAH) leads to reduction in incidence of cerebral infarction, persistent neurological deficits, and poor outcomes. Trials administered it for 21 days; however, we assessed whether a shorter duration might be reasonable for a subset of patients. METHODS: We performed a retrospective single-center study to compare outcomes between patients who received ≤14 days, 15-20 days or ≥21 days of nimodipine. Primary outcome was defined as rate of good functional outcome at final follow-up, assessed using dichotomized modified Rankin Score (mRS). Secondary outcomes included median mRS at follow-up, discharge disposition, and readmission for stroke or vasospasm. RESULTS: 195 patients were included: 101 patients received nimodipine for ≤14 days, 72 patients for 15-20 days, and 22 patients for ≥21 days. There were differences in baseline characteristics of the groups. The shorter duration groups had higher admission GCS score (GCS 15 for ≤14 days, GCS 13 for 15-20 days, GCS 8 for ≥21 days, p = 0.003) and lower Hunt-Hess grade (2 for ≤14 days, 3 for 15-20 days, 4 for ≥21 days, p = 0.001). Of the group of patients that received ≤14 days of nimodipine, 3 patients (3%) were readmitted for concerns for possible stroke or vasospasm, but they did not experience worsening of their functional status related to this. CONCLUSION: Our data suggests a more limited 14-day course of nimodipine therapy after aSAH may be reasonable and efficacious in patients with higher GCS and lower Hunt-Hess grade on presentation.
BACKGROUND: Randomized-controlled trials and meta-analyses showed nimodipine use after aneurysmal subarachnoid hemorrhage (aSAH) leads to reduction in incidence of cerebral infarction, persistent neurological deficits, and poor outcomes. Trials administered it for 21 days; however, we assessed whether a shorter duration might be reasonable for a subset of patients. METHODS: We performed a retrospective single-center study to compare outcomes between patients who received ≤14 days, 15-20 days or ≥21 days of nimodipine. Primary outcome was defined as rate of good functional outcome at final follow-up, assessed using dichotomized modified Rankin Score (mRS). Secondary outcomes included median mRS at follow-up, discharge disposition, and readmission for stroke or vasospasm. RESULTS: 195 patients were included: 101 patients received nimodipine for ≤14 days, 72 patients for 15-20 days, and 22 patients for ≥21 days. There were differences in baseline characteristics of the groups. The shorter duration groups had higher admission GCS score (GCS 15 for ≤14 days, GCS 13 for 15-20 days, GCS 8 for ≥21 days, p = 0.003) and lower Hunt-Hess grade (2 for ≤14 days, 3 for 15-20 days, 4 for ≥21 days, p = 0.001). Of the group of patients that received ≤14 days of nimodipine, 3 patients (3%) were readmitted for concerns for possible stroke or vasospasm, but they did not experience worsening of their functional status related to this. CONCLUSION: Our data suggests a more limited 14-day course of nimodipine therapy after aSAH may be reasonable and efficacious in patients with higher GCS and lower Hunt-Hess grade on presentation.
Authors: Juliette C Thompson; François-Xavier Chalet; Eric J Manalastas; Neil Hawkins; Grammati Sarri; Darren A Talbot Journal: Neurol Ther Date: 2022-04-20