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Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis
Journal
Stroke
ISSN
0039-2499
1524-4628
Date Issued
2015
Author(s)
Sanne M. Dorhout Mees
Ale Algra
George K.C. Wong
Wai S. Poon
Celia M. Bradford
Jeffrey L. Saver
Sidney Starkman
Gabriel J.E. Rinkel
Walter M. van den Bergh
F. van Kooten
C.M. Dirven
J. van Gijn
M. Vermeulen
R. Boet
M.T.V. Chan
T. Gin
S.C.P. Ng
B.C.Y. Zee
R. Al-Shahi Salman
J. Boiten
H. Kuijsten
R.J. van Oostenbrugge
W.P. Vandertop
S. Finfer
A. O’Connor
E. Yarad
R. Firth
R. McCallister
T. Harrington
B. Steinfort
K. Faulder
N. Assaad
M. Morgan
M. Eckstein
S.J. Stratton
F.D. Pratt
S. Hamilton
R. Conwit
D.S. Liebeskind
G Sung
I. Kramer
G. Moreau
R. Goldweber
N. Sanossian
Type
Resource Types::text::journal::journal article
Abstract
<jats:sec>
<jats:title>Background and Purpose—</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods—</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results—</jats:title>
<jats:p>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).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions—</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
Scopus© citations
25
Acquisition Date
May 23, 2024
May 23, 2024