Wanli Yu1, Yizhou Huang2, Xiaolin Zhang1, Huirong Luo3, Weifu Chen1, Yongxiang Jiang4, Yuan Cheng5. 1. Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China. 2. Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China. 3. Department of Psychiatry, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China. 4. Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China. doctorjiang2003@163.com. 5. Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China. chengyuan@hospital.cqmu.edu.cn.
Abstract
OBJECTIVE: To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis. METHODS: Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies. RESULTS: From the 493 of initial citation screening, forty-four RCTs (n = 10,626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR = 3.35,95%CI = 1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA = 87.29%, 95%CrI 0.07-0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR = 1.61, 95%CI 1.01,2.57) and cilostazol (OR = 3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients. CONCLUSIONS: Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.
OBJECTIVE: To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis. METHODS: Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies. RESULTS: From the 493 of initial citation screening, forty-four RCTs (n = 10,626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR = 3.35,95%CI = 1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA = 87.29%, 95%CrI 0.07-0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR = 1.61, 95%CI 1.01,2.57) and cilostazol (OR = 3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients. CONCLUSIONS: Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.
Authors: Andrew A Udy; Chelsey Vladic; Edward Robert Saxby; Jeremy Cohen; Anthony Delaney; Oliver Flower; Matthew Anstey; Rinaldo Bellomo; David James Cooper; David V Pilcher Journal: Crit Care Med Date: 2017-02 Impact factor: 7.598
Authors: Jason Mackey; Jane C Khoury; Kathleen Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Opeolu Adeoye; Daniel Woo; Simona Ferioli; Felipe De Los Rios La Rosa; Sharyl Martini; Pooja Khatri; Joseph P Broderick; Mario Zuccarello; Dawn Kleindorfer Journal: Neurology Date: 2016-10-21 Impact factor: 9.910
Authors: Dennis J Nieuwkamp; Larissa E Setz; Ale Algra; Francisca H H Linn; Nicolien K de Rooij; Gabriël J E Rinkel Journal: Lancet Neurol Date: 2009-06-06 Impact factor: 44.182
Authors: Hector Lantigua; Santiago Ortega-Gutierrez; J Michael Schmidt; Kiwon Lee; Neeraj Badjatia; Sachin Agarwal; Jan Claassen; E Sander Connolly; Stephan A Mayer Journal: Crit Care Date: 2015-08-31 Impact factor: 9.097