Reduction of ischemic sequelae following spontaneous subarachnoid hemorrhage: a double-blind, randomized comparison of enoxaparin versus placebo

Wurm, Gabriele; Tomancok, Berndt; Nußbaumer, Karin; Adelwöhrer, Cornelia; Höll, K.

doi:10.1016/j.clineuro.2004.01.006

Cited by 84 publications

(69 citation statements)

References 32 publications

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“…67 The relationship of infarction to outcome was not examined, but the data show that enoxaparin treatment was associated with reduced localized angiographic vasospasm and cerebral infarction, and with improved outcome at 2 months on the GOS score. Concomitant improvement in outcome and a reduction in infarction support a causative relationship and the potential use of infarction as a surrogate outcome measure.…”

Section: Does Cerebral Infarction Cause Poor Outcome?mentioning

confidence: 99%

“…Important data can be derived from clinical trials of protocols that reduced vasospasm and cerebral infarction. 41,59,67 This is key because these studies simply show a relationship between the two, but do not provide information on cause and effect. Demonstrating a reduction in infarction in association with reduced angiographic vasospasm supports causality and also is an important component of the development of angiographic vasospasm as a surrogate marker.…”

Section: Neurosurg Focus / Volume 21 / September 2006mentioning

confidence: 99%

“…2,58,63 The enoxaparin trial has been discussed earlier in this paper, but the findings have a bearing on this relationship because they show covariance in angiographic vasospasm and outcome. 67 Not all patients underwent angiography (82 [70%] of 117), which introduces bias, but in the ones who did there was a significant decrease in localized angiographic vasospasm and improvement in outcome in the enoxaparin-treated group.…”

Section: Does Angiographic Vasospasm Cause Poor Outcome?mentioning

confidence: 99%

“…67 Intraoperative or postoperative angiography was performed in 82 patients (70%). There were significant decreases in localized angiographic vasospasm (16% in the enoxaparin group compared with 48% in patients receiving placebo), which were associated with a significant decrease in infarction from vasospasm (4% of enoxaparin-treated patients compared with 28% of patients receiving placebo).…”

Section: Neurosurg Focus / Volume 21 / September 2006mentioning

confidence: 99%

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Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Nolan

Macdonald²

2006

FOC

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✓ The authors tested the null hypothesis that published literature with a high level of evidence does not support the assertion that subarachnoid hemorrhage (SAH) causes cerebral vasospasm, which in turn causes cerebral infarction and poor outcome after aneurysmal SAH. The medical literature on SAH was searched in MEDLINE. The author's personal files of all published literature on SAH were reviewed. References cited in Cochrane reviews as well as the published papers that were reviewed were also retrieved. There is no question that SAH causes what the authors have chosen to call “angiographic vasospasm.” However, the incidence and severity of vasospasm in recent series of patients is not well defined. There is reasonable evidence that vasospasm causes infarction, but again, accurate data on how severe and how diffuse vasospasm has to be to cause infarction and how often vasospasm is the primary cause of infarction are not available. There are good data on the incidence of cerebral infarction after SAH, and these data indicate that it is highly associated with poor outcome. The link between angiographic vasospasm and poor outcome is particularly poorly described in terms of what would be considered data of a high level of evidence. The question as to whether there is a clear pathway from SAH to vasospasm to cerebral infarction to poor outcome seems so obvious to neurosurgeons as to make it one not worth asking. Nevertheless, the obvious is not always true or accurate, so it is important to note that published literature only weakly supports the causative association of vasospasm with infarction and poor outcome after SAH. It behooves neurosurgeons to document this seemingly straightforward pathway with high-quality evidence acceptable to the proponents of evidence-based medicine.

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Section: Does Cerebral Infarction Cause Poor Outcome?mentioning

confidence: 99%

Section: Neurosurg Focus / Volume 21 / September 2006mentioning

confidence: 99%

Section: Does Angiographic Vasospasm Cause Poor Outcome?mentioning

confidence: 99%

Section: Neurosurg Focus / Volume 21 / September 2006mentioning

confidence: 99%

See 2 more Smart Citations

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Nolan

Macdonald²

2006

FOC

View full text Add to dashboard Cite

show abstract

“…Other therapies that have been studied include antiplatelet agents [110][111][112] endothelin antagonists [113], intracisternal fibrinolysis [114,115], nitric oxide, and nitric oxide donor compounds [116,117], anticoagulants [118,119] corticosteroids [120], antioxidants [121,122], free radical scavengers [123], and serine protease inhibitors [124]. To date, none have proven efficacious in high quality human studies.…”

Section: Magnesium Sulfatementioning

confidence: 99%