Magnesium as an adjunct to nimodipine in subarachnoid hemorrhage: a meta-analysis.
Study Goal
The researchers aimed to evaluate the efficacy and safety of combining magnesium with nimodipine for managing subarachnoid hemorrhage (SAH).
Results Summary
The combination of magnesium and nimodipine significantly reduced cerebral vasospasm and delayed cerebral ischemia but did not improve functional outcomes, mortality, or secondary cerebral infarction. Adverse events were higher in the combination group but not statistically significant.
Population
Patients with subarachnoid hemorrhage (SAH).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
magnesium plus nimodipine | decrease | cerebral vasospasm (CV) | patients with SAH | odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.95; p=0.03 | significantly reduced the incidence of | #1 |
magnesium plus nimodipine | decrease | delayed cerebral ischemia (DCI) | patients with SAH | OR, 0.52; 95% CI, 0.31-0.87; p=0.01 | significantly reduced the incidence of | #2 |
magnesium plus nimodipine | no change | functional outcomes (modified Rankin Scale) | patients with SAH | OR, 0.97; p=0.75 | no significant differences were found in | #3 |
magnesium plus nimodipine | no change | functional outcomes (Glasgow Outcome Scale) | patients with SAH | OR, 0.81; p=0.24 | no significant differences were found in | #4 |
magnesium plus nimodipine | no change | mortality | patients with SAH | OR, 0.97; p=0.83 | no significant differences were found in | #5 |
magnesium plus nimodipine | no change | secondary cerebral infarction | patients with SAH | OR, 0.38; p=0.12 | no significant differences were found in | #6 |
magnesium plus nimodipine | no change | adverse events | patients with SAH | OR, 3.14; p=0.33 | incidence of adverse events was higher in the combination group; however, this difference was not statistically significant | #7 |
BACKGROUND: Subarachnoid hemorrhage (SAH) is a devastating neurological condition with high morbidity and mortality rates. Although nimodipine is widely used in the management of SAH, the potential benefits of magnesium as adjunct therapy remain unclear. This meta-analysis aimed to evaluate the efficacy and safety of combining magnesium with nimodipine for the management of SAH. METHODS: A comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, and the Cochrane Library. Randomized controlled trials and prospective cohort studies comparing magnesium plus nimodipine versus nimodipine alone in patients with SAH were included. Key outcomes included cerebral vasospasm (CV), delayed cerebral ischemia (DCI), functional outcomes, mortality, and adverse events. RESULTS: Twelve studies involving 2,338 patients were included. The combination of magnesium and nimodipine significantly reduced the incidence of CV (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.95; p=0.03) and DCI (OR, 0.52; 95% CI, 0.31-0.87; p=0.01) compared to nimodipine alone. However, no significant differences were found in functional outcomes (modified Rankin Scale: OR, 0.97; p=0.75; Glasgow Outcome Scale: OR, 0.81; p=0.24), mortality (OR, 0.97; p=0.83), or secondary cerebral infarction (OR, 0.38; p=0.12). The incidence of adverse events was higher in the combination group; however, this difference was not statistically significant (OR, 3.14; p=0.33). CONCLUSION: Adding magnesium to nimodipine therapy in patients with SAH may help reduce CV and DCI incidence but does not significantly improve functional outcomes or mortality. Further large-scale studies are needed to optimize the dosing regimens and confirm these findings.