Pharmacologic Therapy

Calcium Antagonists

© Oral nimodipine is recommended in SAH to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.48

Hemostatic Therapy

Recombinant factor VIIa has been shown to have a benefit in the treatment of ICH. The Recombinant Activated Factor VII Intracerebral Hemorrhage Trial compared three different doses and placebo. Doses were 40, 80, or 160 mcg/kg or placebo given as an IV infusion over 1 to 2 minutes within 4 hours after the onset of symptoms. Hematoma growth was decreased at 24 hours, mortality was decreased at 90 days, and overall functioning was increased at 90 days.49 A recent phase III trial showed that recombinant factor VIIa decreased growth of the hematoma, but did not improve survival or functional outcome.50 Current treatment guidelines suggest that recombinant factor VIIa infused within the first 3 to 4 hours after onset may be beneficial; however, further study is required before this treatment can be recommended outside of a clinical trial.46

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