Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review

Santos‐Teles, Alex Goes; Ramalho, Clara; Ramos, João Gabriel Rosa; Passos, Rogério da Hora; Gobatto, André Luiz Nunes; Farias, Suzete; Batista, Paulo Benígno Pena; Caldas, Juliana

doi:10.5935/0103-507x.20200097

Cited by 9 publications

(3 citation statements)

References 54 publications

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“…102 Additionally, the vasodilators milrinone and clazosentan have shown decreased cerebral vasospasm risk in small studies. 103,104 Other drugs, such as magnesium and statins, have been investigated in larger trials. The magnesium in aneurysmal SAH-2 trial (MASH-2) failed to demonstrate a benefit of intravenous magnesium sulfate after SAH.…”

Section: Sex-based Response To Medical Therapiesmentioning

confidence: 99%

Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Fuentes

McGuire

Amin‐Hanjani

2022

Stroke

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Sex differences in cerebral aneurysm occurrence and characteristics have been well described. Although sex differences in outcomes following ischemic stroke have been identified, the effect of sex on outcomes following hemorrhagic stroke, and in particular, aneurysm treatment has been less studied. We describe the current state of knowledge regarding the impact of sex on treatment and outcomes of cerebral aneurysms. Although prior studies suggest that aneurysm prevalence and progression may be related to sex, we did not find clear evidence that outcomes following subarachnoid hemorrhage vary based on sex. Last, we identify areas for future research that could enhance understanding of the role sex plays in this context.

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Section: Sex-based Response To Medical Therapiesmentioning

confidence: 99%

Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Fuentes

McGuire

Amin‐Hanjani

2022

Stroke

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“…It is important to highlight that in our case, cerebral angiography showed that there was no generalized vasospasm, but worsening of previous vasospasm secondary to surgical manipulation and high levels of serotonin exposure, which narrowed the vascular lumen and caused transient ischemia to its irrigated supplied structures[4,7].Regarding treatment, there are no specific guidelines for these cases and management is based on observational data and expert opinions. Since 2001, Milrinone, a potent vasodilator drug with a positive inotropic effect for inhibiting phosphodiesterase, has been consolidated mainly in case reports, as a useful drug in situations of cerebral vasoconstriction syndrome[8,9]. In our case, the patient had significant benefits and excellent response to intraarterial Milrinone, with immediate reversal of vasoconstriction and progressive clinical improvement initiated at the time of drug's administration.…”

mentioning

confidence: 68%

Worsening of Previous Vasospasm after Sertraline Ingestion: A Reversible Cerebral Vasoconstriction Syndrome Spectrum?

BM¹

2021

AICS

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Reversible cerebral vasoconstriction syndrome (RCVS), or Call-Fleming syndrome, is a rare entity of multifactorial etiology characterized by the narrowing of multiple cerebral arteries, presenting clinically in patients with sudden headache, seizures and sometimes neurological deficits [1,2]. The pathophysiological mechanism has not yet been fully elucidated and the possible factors involved in its genesis include the increase in oxidative stress, endothelial dysfunction, transient failure of regulation of cerebral arterial tone in the face of sympathetic hyperactivity, genetic predisposition, among others [3].Triggers are identified in approximately 50% of cases and time between exposure and development of RCVS can be from few days to months, which is a diagnostic challenge, given its low incidence and numerous associated factors. Among the possible causes are neurosurgery, hypertensive encephalopathy, pregnancy and some vasoactive drugs. The increasing use of antidepressant drugs, nasal decongestants and triptans, and illicit drugs, including amphetamines, cocaine, ecstasy and cannabis has resulted in significant increase in the number of cases [4].We present a case report of a young patient, previously asymptomatic; with a mild vasospasm secondary to a sphenoidal frontotemporal meningioma resection that had a stroke-like episode after ingest 150mg of Sertraline due to potential worsening of the previous Crimson PublishersWings to the Research

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“…Evaluation of clinical efficacy: After treatment, the clinical efficacy of the two groups was evaluated. The evaluation criteria: 9 Remarkably effective: the cerebral blood flow velocity of CVS patients returned to normal level, the damaged neurological function was significantly repaired, the clinical symptoms and signs basically disappeared, and the self-care ability was completely restored; effective: the cerebral blood flow velocity and neurological function of the patients were partially recovered, the clinical symptoms were relieved, and the self-care ability was basically achieved; invalid: the clinical symptoms and signs of the patients were not significantly improved or even aggravated. The total effective rate = remarkably effective rate + effective rate.…”

Section: Methodsmentioning

confidence: 99%

Clinical evaluation of Alprostadil combined with Nimodipine in treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage in elderly patients

Liu¹,

Gan²,

Xie³

et al. 2023

Pak J Med Sci

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Objective: To analyze the clinical efficacy of alprostadil combined with nimodipine in the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) in elderly patients. Methods: This is a retrospective study. According to different treatment methods, the elderly 100 patients with CVS after SAH hospitalized in Baoding First Central Hospital from March 2020 to May 2021 were randomly divided into control group and observation group, with 50 patients in each group. The control group was treated with nimodipine, while the observation group was additionally combined with alprostadil. The levels of inflammatory factors and hemorheological indexes were measured before and after treatment. The clinical efficacy was compared and the adverse reactions were observed of the two groups. Results: The overall clinical efficacy in the observation group (95.00%) was significantly higher than that in the control group (74.00%) (p<0.05). After treatment, serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), high-sensitivity C-reactive protein (hs-CRP) and hemorheological indexes such as plasma viscosity, whole blood viscosity at high shear, whole blood viscosity at low shear, hematocrit and platelet adhesion decreased significantly compared with those before treatment (p<0.05), which were more obvious in the observation group (p<0.05). During treatment, the rate of adverse reactions in the observation group was 12.00%, and that in the control group was 8.00%, without statistically significant difference between the two groups (p> 0.05). Conclusion: Alprostadil combined with nimodipine is markedly effective in the treatment of CVS after SAH in elderly patients. It can effectively reduce inflammatory factor levels and improve hemorheological indexes in patients, which is conducive to the repair of neurological function. doi: https://doi.org/10.12669/pjms.39.3.6753 How to cite this: Liu S, Gan N, Xie J, Zhang Y, Su F, Jia T. Clinical evaluation of Alprostadil combined with Nimodipine in treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage in elderly patients. Pak J Med Sci. 2023;39(3):682-686. doi: https://doi.org/10.12669/pjms.39.3.6753 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review

Cited by 9 publications

References 54 publications

Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage

Worsening of Previous Vasospasm after Sertraline Ingestion: A Reversible Cerebral Vasoconstriction Syndrome Spectrum?

Clinical evaluation of Alprostadil combined with Nimodipine in treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage in elderly patients

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