EFFICACY OF PROPHYLACTIC NIMODIPINE FOR DELAYED ISCHEMIC DEFICIT AFTER SUBARACHNOID HEMORRHAGE - A METAANALYSIS

The authors report findings from a metaanalysis of all published rando mized trials of prophylactic nimodipine used in patients who have expe rienced subarachnoid hemorrhage (SAH). Seven trials were included with a total of 1202 patients suitable for evaluation. Eight outcome measu res were examined, including good versus other outcome, good or fair o utcome versus other outcome, overall mortality, deficit and/or death a ttributed to vasospasm, infarction rate as judged by computerized tomo graphy :CT), and deficit and/or death from rebleeding. Nimodipine impr oved outcome according to all measures examined. The odds of good and of good plus fair outcomes were improved by ratios of 1.86:1 and 1.67: 1, respectively, for nimodipine versus control (p < 0.005 for both mea sures). The odds of deficit and/or mortality attributed to vasospasm a nd CT-assessed infarction rate were reduced by ratios of 0.46:1 to 0.5 8:1 in the nimodipine group (p < 0.008 for all measures). Overall mort ality was slightly reduced in the nimodipine group, but the trend was not statistically significant. The rebleeding rate was not increased b y nimodipine. A metaregression yielded findings indicating that the tr eatment effect of nimodipine in individual trials was positively corre lated with the severity of SAH in enrolled patients. Although the majo rity of individual trials examined did not have statistically signific ant results at the p < 0.01 level according to most outcome measures, the metaanalyses confirmed the significant efficacy of prophylactic ni modipine in improving outcome after SAH under the conditions used in t hese trials.