Key result
Endothelin-receptor antagonists reduced delayed ischemic neurological deficits (OR 0.68; 95% CI 0.49-0.95) but did not improve mortality or poor neurological outcomes.
Why the study?
Do endothelin-receptor antagonists prevent delayed neurological deficits and poor outcomes in patients with aneurysmal subarachnoid hemorrhage?
Meta-Analysis (n=867)
Do endothelin-receptor antagonists prevent delayed neurological deficits and poor outcomes in patients with aneurysmal subarachnoid hemorrhage?
While endothelin-receptor antagonists reduce radiographic vasospasm and delayed ischemic neurological deficits after subarachnoid hemorrhage, they do not improve mortality or neurological outcomes and are associated with increased hypotension and pulmonary complications.
Endothelin-receptor antagonists should not be used routinely after aneurysmal subarachnoid hemorrhage; challenges surrogate endpoints like delayed ischemic deficits for guiding practice or trials.
BACKGROUND AND PURPOSE: Delayed ischemic neurological deficits (DINDs) contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Endothelin-1 is an important mediator involved in the development of vasospasm. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials assessing the use of endothelin-receptor antagonists (ETRAs) in patients with SAH. RESULTS: Three studies met eligibility criteria, enrolling 867 patients. ETRAs significantly reduced the occurrence of DINDs (OR 0.68 [0.49 to 0.95]) and radiographic vasospasm (OR 0.31 [0.19 to 0.49]), but did not have any impact on mortality (OR 1.09 [0.69 to 1.72]) or poor neurological outcomes (OR 0.87 [0.63 to 1.20]). Any benefit of ETRAs may have been partially offset by adverse effects, including hypotension(OR 2.39 [1.37 to 4.17]) and pulmonary complications (OR 2.12 [1.51 to 2.98]). CONCLUSIONS: Although ETRAs reduce radiographic vasospasm and DINDs, there is currently no evidence that they improve outcomes.
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Kramer et al. (2009) conducted a meta-analysis in Aneurysmal subarachnoid hemorrhage (SAH) (n=867). Endothelin-receptor antagonists (ETRAs) vs. Control was evaluated on Delayed ischemic neurological deficits (DINDs) (OR 0.68, 95% CI 0.49 to 0.95). Endothelin-receptor antagonists reduced delayed ischemic neurological deficits (OR 0.68; 95% CI 0.49-0.95) but did not improve mortality or poor neurological outcomes.
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