Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Abstract

Background Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) recovery may be hampered by delayed cerebral ischemia (DCI). Herein, we sought to identify an association of DCI with frequently administered medications in the neurointensive care unit (neuro-ICU). Methods In this retrospective study, patients admitted to a tertiary care center neuro-ICU between 2012–2019 with aSAH who could verbalize pain intensity scores were included. Medication dosages and clinical characteristics were abstracted from the medical record. Both paired (within subjects) and unpaired (across subjects) non-parametric analyses were utilized to measure individual DCI risk for a given patient in relation to drug dosages. Results 119 patients were included; average age was 61.7 ± 15.2 (SD) years, 89 (74.7%) were female, and 32 (26.9%) experienced DCI during admission. Patients with DCI had longer length of stay (19.3 ± 7.4 vs 12.7 ± 5.3 days, p < 0.0001). The combination medication of acetaminophen 325 mg/butalbital 50 mg/caffeine 40 mg (A/B/C; Fioricet®) was associated with decreased DCI on paired (2.3 ± 2.0 vs 3.1 ± 1.9 tabs, p = 0.034) and unpaired analysis (1.84 ± 2.4 vs 2.6 ± 2.4 tabs, p < 0.001). No associations were found between DCI and opioids, dexamethasone, levetiracetam, or acetaminophen. Max and mean daily headache pain was not associated with DCI occurrence. Conclusion We identified a dose-response relationship between a commonly administered analgesic and DCI. A/B/C is associated with decreased DCI in this study both within and across subjects, while other medications are not associated with DCI.