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(Stroke. 2008;39:514.)
© 2008 American Heart Association, Inc.

Cochrane Corner

Calcium Antagonists for Aneurysmal Subarachnoid Hemorrhage

Sanne M. Dorhout Mees, MD; Gabriel J.E. Rinkel; Valery L. Feigin, MD, MSc, PhD; Ale Algra, MD; Walter M. van den Bergh, MD, PhD; Marinus Vermeulen, MD Jan van Gijn, MD, FRCP, FRCP(E)

From the Department of Neurology (S.M.D.M., G.J.E.R., W.M.v.d.B, J.v.G.), Rudolf Magnus Institute of Neuroscience; the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; the Academic Medical Center (M.V.), Amsterdam, the Netherlands; and the School of Population Health (V.L.F.), The University of Auckland, New Zealand.

Correspondence to Prof Gabriel J.E. Rinkel, MD, Professor of Neurology, Department of Neurology, University Medical Centre Utrecht, PO Box 85500, Utrecht, the Netherlands. E-mail G.J.E.Rinkel@umcutrecht.nl

Graeme J. Hankey MD, FRCP Section Editor:

Key Words: randomized controlled trials • subarachnoid hemorrhage • calcium antagonists

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Secondary ischemia is a frequent cause of poor outcome in patients with subarachnoid hemorrhage (SAH). Its pathogenesis has been incompletely elucidated, but vasospasm probably is a contributing factor. Experimental studies have suggested that calcium antagonists can prevent or reverse vasospasm and have neuroprotective properties.

	Objective

 
The objective of this study was to determine, in a systematic review of all randomized clinical trials (RCT), whether calcium antagonists improve outcome in patients with aneurysmal SAH.

	Search Strategy

 
We aimed to include all RCTs on calcium antagonists in aneurysmal SAH. The Cochrane Stroke Group Trials Register (last searched April 2006), MEDLINE (1966 to March 2006), and EMBASE (1980 to March 2006) were searched. We hand searched 2 Russian journals (1990 to 2003), and contacted trialists and pharmaceutical companies in 1995 and 1996.

	Selection Criteria

 
We included RCTs comparing calcium antagonists with control, or a second calcium antagonist (magnesium sulfate) versus control in addition to another calcium antagonist (nimodipine) in both the intervention and control groups.

	Data Collection and Analysis

 
Two reviewers independently extracted the data and assessed trial quality. Trialists were contacted to obtain missing information.

	Main Results

 
Sixteen trials (4 new since the previous review), involving 3361 patients, were included in the review; 3 trials studied magnesium sulfate in addition to nimodipine. In most included RCTs the aneurysms were treated by surgical clipping. Overall, calcium antagonists reduced the risk of poor outcome: the relative risk (RR) was 0.81 (95% confidence interval [CI] 0.72 to 0.92); the corresponding number of patients needed to treat was 19 (95% CI 1 to 51; Figure). For . . . [Full Text of this Article]

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