http://stroke.ahajournals.org/content/46/11/3190.abstract
Abstract
Background and Purpose—Delayed
cerebral ischemia (DCI) is an important cause of poor outcome after
aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment
starting <4 days after symptom onset found no effect on poor outcome
or DCI in SAH. Earlier installment of treatment might be more effective,
but individual trials had not enough power for such a subanalysis. We
performed an individual patient data meta-analysis to study whether
magnesium is effective when given within different time frames within 24
hours after the SAH.
Methods—Patients
were divided into categories according to the delay between symptom
onset and start of the study medication: <6, 6 to 12, 12 to 24, and
>24 hours. We calculated adjusted risk ratios with corresponding 95%
confidence intervals for magnesium versus placebo treatment for poor
outcome and DCI.
Results—We
included 5 trials totaling 1981 patients; 83 patients started treatment
<6 hours. For poor outcome, the adjusted risk ratios of magnesium
treatment for start <6 hours were 1.44 (95% confidence interval,
0.83–2.51); for 6 to 12 hours 1.03 (0.65–1.63), for 12 to 24 hours 0.84
(0.65–1.09), and for >24 hours 1.06 (0.87–1.31), and for DCI, <6
hours 1.76 (0.68–4.58), for 6 to 12 hours 2.09 (0.99–4.39), for 12 to 24
hours 0.80 (0.56–1.16), and for >24 hours 1.08 (0.88–1.32).
Conclusions—This
meta-analysis suggests no beneficial effect of magnesium treatment on
poor outcome or DCI when started early after SAH onset. Although the
number of patients was small and a beneficial effect cannot be
definitively excluded, we found no justification for a new trial with
early magnesium treatment after SAH.
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