Initial results of clazosentan with multiple-drug management for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Abstract

Objective: Cerebral vasospasm is an unelucidated complication of subarachnoid hemorrhage. Various treatments exist against cerebral vasospasms however, consensus on the optimal treatment is lacking. We use clazosentan, which is used to prevent cerebral vasospasm, with multidrug combinations. In this study, we aimed to clarify the initial results of using clazosentan in multidrug combinations in the real world. Methods: We retrospectively investigated 54 patients who were treated for subarachnoid hemorrhage and received clazosentan. We compared the results of these patients on the basis of two groups: those with good outcomes (modified Rankin scale score: 0–3) and poor outcomes (4–6) at discharge. Results: Among the patients, poor outcome was observed in 19 patients (35.2 %). Angiographic vasospasms occurred in 10 patients (good outcome [n = 6] vs. poor outcome [n = 4]; p = 0.73), and symptomatic vasospasms occurred in 4 patients (n = 2 vs. n = 2, p = 0.61). The incidence of pleural effusion (28.6 % vs. 73.7 %, p < 0.01) and the mean daily fluid balance (303.5 mL/day vs. 785.4 mL/day, p < 0.01) were higher in the poor outcome group. Conclusion: Pleural effusion and high positive balance may be associated with poor outcome. However, the number of cases examined was small; therefore, further large-scale studies with a bigger sample size are needed.

Keywords

• Clazosentan
• Angiographic vasospasm
• Symptomatic vasospasm
• Subarachnoid hemorrhage
• Pleural effusion
• Pulmonary edema