Pharmacotherapy in SAH: Clinical Trial Lessons.
Sotirios ApostolakisPantelis StavrinouPublished in: CNS & neurological disorders drug targets (2024)
Subarachnoid Haemorrhage (SAH) is a medical emergency with potentially devastating outcomes. It is without doubt that over the past decades, there has been a radical change in the approach towards patients with SAH, both in terms of the surgical as well as of the pharmacological treatments offered. The present review aims to outline the principal data regarding the best practice in the pharmacotherapy of SAH, as well as to sum up the emerging evidence from the latest clinical trials. To date, nimodipine is the only evidence-based treatment of vasospasm. However, extensive research is currently underway to identify novel substances with magnesium sulphate, cilostazol, clazosentan and fasudil, demonstrating promising results. Antifibrinolytic therapy could help reduce mortality, and anticoagulants, in spite of their associated hazards, could actually reduce the incidence of delayed cerebral ischemia. The effectiveness of triple-H therapy has been challenged, yet evidence on the optimal regimen is still pending. Statins may benefit some patients by reducing the incidence of vasospasm and delayed ischemic events. As several clinical trials are underway, it is expected that in the years to come, more therapeutic options will be added to the attending physician's armamentarium.
Keyphrases
- clinical trial
- subarachnoid hemorrhage
- cerebral ischemia
- brain injury
- risk factors
- healthcare
- primary care
- emergency department
- end stage renal disease
- blood brain barrier
- phase ii
- newly diagnosed
- randomized controlled trial
- cardiovascular disease
- chronic kidney disease
- ejection fraction
- open label
- systematic review
- study protocol
- phase iii
- type diabetes
- machine learning
- peritoneal dialysis
- patient reported outcomes
- skeletal muscle
- bone marrow
- oxidative stress
- combination therapy
- ischemia reperfusion injury
- cell therapy