Nimodipine prophylaxis in aneurysmal subarachnoid hemorrhage, a question of tradition or evidence: A scoping review.

Eva Malacova, Kevin B Laupland, Jason A Roberts, Judith Bellapart, Jennifer Paratz

Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2024;123():91-99

PMID: 38564967

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The prophylactic use of nimodipine following subarachnoid hemorrhage is a practice established four decades ago when clinical management differed from current and the concept of Delayed Cerebral Ischemia (DCI) was not established. The applicability of the original studies is limited by the fact of not reflecting current practice; by utilising a dichotomised outcome measure such as good neurological outcome versus death and vegetative state; by applying variable dosing regimens and including all causes of poor neurological outcome different than DCI. This study aims to review the available evidence to discuss the ongoing role of nimodipine in contemporaneous clinical practice.

METHODS

PRISMA guidelines based review, evaluated the evidence on the prophylactic use of nimodipine. The following search engines: Medline, Embase, Cochrane, Web of Science and PubMed, identified Randomized Control Trials (RCTs) with neurological benefit as outcome measure and the impact of fixed versus weight-based nimodipine dosing regimens.

RESULTS

Eight RCT were selected. Three of those trials with a total of 349 patients, showed a reduction on death and vegetative state (pooled RR: 0.62; 95 % confidence interval-CI: 0.45, 0.86) related to DCI. Amongst all studies, all cause death (pooled RR = 0.73, [95 % CI: 0.56, 0.97]) favoured a fixed-dose regimen (pooled RR: 0.60; [95 % CI: 0.43, 0.85]).

CONCLUSION

Available evidence demonstrates that nimodipine only reduces the risk for DCI-related death or vegetative state and that fixed-dose regimens favour all cause infarct and death independent of DCI. Contemporaneous studies assessing the benefit of nimodipine beyond death or vegetative states and applying individualized dosing are warranted.

Address: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Burns Trauma and Critical Care Research Centre, the University of Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, 4029, Brisbane, Australia. Electronic address: [email protected].; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology (QUT), Brisbane, Australia. Electronic address: [email protected].; QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, 4006, Australia. Electronic address: [email protected].; University of Queensland Centre of Clinical Research (UQCCR), the University of Queensland, Herston, Brisbane, Australia; Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia. Electronic address: [email protected].; School of Allied Health Sciences, Griffith University, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia. Electronic address: [email protected].

DOI: 10.1016/j.jocn.2024.03.016

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MeSH Terms: Nimodipine, Humans, Subarachnoid Hemorrhage, Calcium Channel Blockers, Vasodilator Agents, Randomized Controlled Trials as Topic