Key result
Adding loop diuretics to clazosentan is linked to less pulmonary edema and asymptomatic vasospasm in aSAH.
Why the study?
Pulmonary edema is a common complication in patients receiving clazosentan for vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage, requiring evaluation of fluid balance management with loop diuretics.
Does the addition of loop diuretics to clazosentan therapy reduce the incidence of pulmonary edema and vasospasm in patients with aneurysmal subarachnoid hemorrhage?
Observational
Does the addition of loop diuretics to clazosentan therapy reduce the incidence of pulmonary edema and vasospasm in patients with aneurysmal subarachnoid hemorrhage?
Proper management of fluid balance with loop diuretics can effectively reduce pulmonary edema incidence during clazosentan therapy for vasospasm prophylaxis in aSAH patients.
May support loop diuretic addition to clazosentan to limit edema in aSAH; hypothesis-generating and requires prospective confirmation.
Pulmonary edema is a common complication in patients receiving clazonsentan. Here, we report our experience in managing fluid balance with loop diuretics in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated with clazosentan. Patients with aSAH who received prophylactic agents for vasospasm after aneurysm obliteration between June 2021 and April 2023 were enrolled. Fluid balance parameters and asymptomatic and symptomatic vasospasm and pulmonary edema incidence were compared in three periods: 1st period (fasudil therapy), 2nd period (clazosentan therapy alone), and 3rd period (clazosentan with loop diuretic therapy). Fluid intake and urine volume during the 2nd and 3rd periods were considerably lesser than those during the 1st period. Asymptomatic vasospasm incidence was considerably lesser in the 3rd period than that in the 1st and 2nd periods. However, the incidences of symptomatic vasospasm and rescue endovascular treatment were comparable among the three groups. Although the clinical outcomes at the last follow-up were comparable among the three groups, pulmonary edema incidence was markedly higher during the 2nd period than that in the 1st and 3rd periods. Thus, proper management of fluid balance with clazosentan and diuretics would help in effective clazosentan therapy for vasospasm prophylaxis.
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Akamatsu et al. (2023) conducted an observational in aneurysmal subarachnoid hemorrhage (aSAH). Clazosentan with loop diuretic therapy vs. Fasudil therapy and clazosentan therapy alone was evaluated on Fluid balance parameters and incidence of vasospasm and pulmonary edema. Clazosentan with loop diuretic therapy was associated with lower pulmonary edema and asymptomatic vasospasm incidence compared to clazosentan alone in patients with aneurysmal subarachnoid hemorrhage.
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