Effects of clazosentan, cilostazol, and statins on aneurysmal subarachnoid hemorrhage

Abstract

Background : Aneurysmal subarachnoid hemorrhage (aSAH) is a disease caused by the infiltration of blood into the subarachnoid space due to the rupture of an intracranial aneurysm. It is a serious cerebrovascular disease, with a mortality rate of about 40% worldwide, which seriously threatens human life and health. Many drugs are used to treat aSAH and its complications, and some have been tested in systematic reviews and have shown good effects. But which drug has the best effect remains unclear. This network meta-analysis (NMA) aims to assess the effectiveness and feasibility of clazosentan, cilostazol, and statins in patients with aSAH. Methods : We will search for EMBASE.com, PubMed, the Cochrane Library, and Web of Science from inception to December 2019. Randomized controlled trials (RCTs) reporting efficacy and safety of clazosentan, cilostazol, and statins compared with the control, or compared with each other for the treatment of aSAH will be included. Two independent reviewers will assess the risk of bias of the included RCTs with the Cochrane “Risk of bias” tool. The pairwise meta-analysis will be performed with the random-effects model. The NMA will be performed in a Bayesian hierarchical framework using Markov Chain Monte Carlo method in WinBUGS 1.4.3. Egger test and funnel plot will be used to assess the publication bias. We will evaluate the quality of evidence for each outcome according to the GRADE approach. Results : The results of this NMA will be submitted to a peer-reviewed journal for publication. Conclusion : This study will summarize up-to-date evidence to compare the efficacy and safety of clazosentan, cilostazol, and statins on aSAH. PROSPERO registration number: CRD42019147523.

Cilostazol Administration for Subarachnoid Hemorrhage: A Meta-analysis of Randomized Controlled Trials

“…Many factors result in the incidence of DCI and include persistent luminal narrowing of the major cerebral arteries, microcirculatory disturbance, early brain injury, and cortical spreading depression 5–7 . Many drugs and treatments have been develop to alleviate cerebral vasospasm and prevent DCI 8–11 …”

“…[5][6][7] Many drugs and treatments have been develop to alleviate cerebral vasospasm and prevent DCI. [8][9][10][11] Cilostazol, a selective inhibitor of phospho-diesterase 3, were reported as an efficacious drug for the prevention of cerebral vasospasm in experimental studies. 12,13 Cilostazol has been widely used for arteriosclerosis obliterans, the intermittent claudication, and the prevention of second ischemic stroke.…”