Effectiveness comparisons of drug therapies for postoperative aneurysmal subarachnoid hemorrhage patients: network meta‑analysis and systematic review

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.

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

“…Although many studies have reported that nimodipine and cilostazol can reduce DCI in patients with SAH, there are few reports on whether the combined treatment of both drugs has a better effect in preventing DCI [11,35]. Our data showed that the use of cilostazol combined with nimodipine decreases the incidence of DCI and ACV compared to nimodipine alone.…”

“…Cilostazol is another option drug studied to prevent ACV [35]. Experimental and small clinical studies have shown good prognostic results in reducing ACV and DCI [36][37][38].…”

Effects of Pulsatile Flow Rate and Shunt Ratio in Bifurcated Distal Arteries on Hemodynamic Characteristics Involved in Two Patient-Specific Internal Carotid Artery Sidewall Aneurysms: A Numerical Study

“…Specifically, hemodynamic characteristics, i.e., flow patterns, wall shear stress ( ), oscillatory shear index ( ), and time-averaged pressure ( TAP ), play an important role in the formation, growth, and rupture of cerebral aneurysms, and should be identified precisely using qualitative and quantitative manners [ 13 , 14 , 15 , 16 , 17 ]. So far, the risks associated with various factors (i.e., aneurysmal dome locations, high-risk aneurysmal morphologies, pre- and post-treatment states, and arterial blood flow conditions) on the pathophysiology of CAs have been estimated, to some extent, using different research strategies (i.e., in vivo, in vitro, and in silico), which were summarized by previous efforts [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Nevertheless, the pulsatile flow rates are typically patient-specific [ 26 , 27 ], and many studies had tentative investigations on how the varying pulsatile blood flow rates/pressures will influence hemodynamic characteristics (i.e., and ) in cerebral arteries or CAs [ 28 , 29 , 30 , 31 , 32 , 33 ].…”

The efficacy of different nimodipine administration route for treating subarachnoid hemorrhage: A network meta-analysis

“…[ 38 ] The studies have different conclusions about the best agents to use after SAH. For instance, Yu et al [ 39 ] concluded that nimodipine and cilostazol are effective, while Dayyani et al [ 40 ] suggested that nimodipine, nimodipine with magnesium, and high-dose clazosentan could potentially prevent morbidity and mortality. Lastly, Mishra et al [ 41 ] found that nicardipine prolonged-release implants and cilostazol could improve outcomes after SAH.…”