Abstract 3355: Combination Therapy With Magnesium Sulfate And Nimodipine For The Prevention Of Symptomatic Cerebral Vasospasm In Aneurysmal Subarachnoid Hemorrhage
Background and Purpose- Magnesium treatment can cause dose-dependent vasodilatation and improve cerebral blood flow. This investigation was conducted to evaluate efficacy of the combination therapy with magnesium and nimodipine in patients with aneurysmal subarachnoid hemorrhages (SAH).
Methods- This retrospective analysis was performed in 143 patients who presented with ruptured aneurysms from January 2007 to April 2011 at a single center. Nimodipine alone was infused in 89 patients until October 2009, and the combination of magnesium with nimodipine was infused in 54 patients after November 2009. The combination therapy and nimodipine-only treatment was started 13.1 ± 7.7 h (median ± SD) and 13.8 ± 11.2 h, respectively, after SAH symptom development. Magnesium treatment was maintained at a dose of 64 mmol/L per day for fourteen days.
Results- Symptomatic vasospasm developed in 6 patients (11.1%) in the combination-treatment group and 26 (29.2%) in the nimodipine-only group. Thus, treatment with magnesium significantly reduced the incidence of symptomatic vasospasms (Odds Ratio, 0.285; 95% Confidence Interval, 0.102-0.794; p = .016). Duration of the vasospasm was shorter in the combination-treatment group (2.7 ± 0.8 days vs 6.4 ± 4.3 days; p = .000). No complications associated with magnesium treatment were observed.
Conclusion- Early treatment with magnesium and nimodipine reduced the incidence of symptomatic cerebral vasospasms in patients with aneurysmal SAH, and 64 mmol/L per day without the supplementation of magnesium to attain a specific concentration of high serum magnesium, was sufficient to prevent vasospasms.
- © 2012 by American Heart Association, Inc.