Key result
Midodrine reduced the risk of at least 1 syncope episode compared to placebo (42% vs 61%; RR 0.69; 95% CI 0.49-0.97; P=0.035) in patients with recurrent vasovagal syncope.
Why the study?
Recurrent vasovagal syncope is common and responds poorly to treatment. Although midodrine prevents hypotension and syncope during tilt tests, whether it prevents vasovagal syncope in usual clinical conditions was unknown.
Does midodrine prevent recurrent syncope in patients with vasovagal syncope?
Population
133 patients with recurrent vasovagal syncope and no serious comorbid conditions
Comparison
Midodrine vs placebo
Design
Multicenter randomized double-blind placebo-controlled clinical trial
Follow-up
12 months
Authors
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Supports midodrine for recurrent vasovagal syncope; confirms benefit in dedicated RCT.
RCT (n=133)
Double-blind
1:1
Yes
Does midodrine prevent recurrent syncope in patients with vasovagal syncope?
Relative Risk: 0.69 (95% CI 0.49–0.97)
Absolute Event Rate: 42% vs 61%
Absolute Risk Reduction: 19%
Number Needed to Treat: 5.3
p-value: p=0.035
Midodrine significantly reduces the recurrence of syncope in young, healthy patients with a high burden of vasovagal syncope.
Sheldon et al. (2021) conducted an RCT in Recurrent vasovagal syncope (n=133). Midodrine vs. Placebo was evaluated on Proportion of patients with at least 1 syncope episode during follow-up (RR 0.69, 95% CI 0.49 to 0.97, p=0.035). Midodrine reduced the risk of at least 1 syncope episode compared to placebo (42% vs 61%; RR 0.69; 95% CI 0.49-0.97; P=0.035) in patients with recurrent vasovagal syncope.
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