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(Stroke. 2005;36:1816.)
© 2005 American Heart Association, Inc.

Cochrane Corner

Calcium Antagonists in Aneurysmal Subarachnoid Hemorrhage

G.J.E. Rinkel, MD; V.L. Feigin, MD; A. Algra, MD; W.M. van den Bergh, MD; M. Vermeulen, MD J. van Gijn, MD, FRCP, FRCP(E)

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

Correspondence to Dr G.J.E. Rinkel, Department of Neurology, Room G03.228, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail g.j.e.rinkel@neuro.azu.nl

Section Editors: Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACP

Key Words: aneurysm • randomized controlled trial • review • subarachnoid hemorrhage

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

	Background

 
Secondary ischemia is a frequent cause of poor outcome in patients with subarachnoid hemorrhage (SAH). The cause of secondary ischemia is unknown, but may be related to vasospasm, at least in part. In experimental studies calcium antagonists prevent or reverse vasospasm and have neuroprotective properties. Various types of calcium antagonists have been studied in several clinical trials.

	Objective

 
To determine the effectiveness of calcium antagonists for improving outcome in patients with aneurysmal SAH.

	Methods

 
Search Strategy
We searched the Cochrane Stroke Group Trials Register (September 2003). In addition, we searched MEDLINE (1966 to October 2003) and EMBASE (1980 to October 2003), hand-searched two Russian journals (1990 to 2003), and contacted trialists and pharmaceutical companies (in 1995 and 1996) to identify further studies.

Selection Criteria
All randomized controlled trials comparing any calcium antagonist with control.

Data Collection and Analysis
Two reviewers independently extracted data and assessed trial quality. Trialists were contacted to obtain missing information. Primary analyses were based on the intention-to-treat results of the individual trials, for "poor outcome" (death or dependence), and for case fatality.

	Results

 
We analyzed 12 trials totaling 2844 patients with SAH. The drugs analyzed were: nimodipine (8 trials), nicardipine (2 trials), AT877 (1 trial) and magnesium sulfate (1 trial).

Overall, calcium antagonists reduced the risk of poor outcome: the relative risk (RR) was 0.82 (95% confidence interval (CI), 0.72 to 0.93; Figure); the number of patients needed to treat (NNT) to prevent a single poor outcome event was 20 (95% CI, 12 to 59). For oral nimodipine alone the RR was 0.70 (0.58 to 0.84); . . . [Full Text of this Article]