Cilostazol May Improve Outcomes Even in Patients with Aneurysmal Subarachnoid Hemorrhage Aged 75 Years and Older: Multicenter Cohort Study and Propensity Score-Matched Analyses.

Autor: Nakajima H; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: zima0131@gmail.com., Okada T; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Kawakita F; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Oinaka H; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Suzuki Y; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Nampei M; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Kitano Y; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Nishikawa H; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Fujimoto M; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Miura Y; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Yasuda R; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Toma N; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan., Suzuki H; Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Jan; Vol. 181, pp. e273-e290. Date of Electronic Publication: 2023 Oct 13.
DOI: 10.1016/j.wneu.2023.10.039
Abstrakt: Background: The opportunities to treat elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) are increasing globally, but the outcome remains poor. This study seeks to investigate treatment-related factors that can modify functional outcomes in patients with aSAH aged ≥75 years.
Methods: A total of 202 patients with aSAH aged ≥75 years prospectively enrolled in 9 primary stroke centers from 2013 to 2021 were retrospectively analyzed. Clinical variables including treatments for hydrocephalus, angiographic vasospasm, and delayed cerebral ischemia were compared between patients with good (modified Rankin Scale [mRS] score 0-2) and poor (mRS score 3-6) outcomes at 90 days from onset, followed by multivariate analyses to find independent outcome determinants. A modifiable treatment-related variable was evaluated after propensity score matching with adjustments for age, sex, pre-onset mRS score, aSAH severity, and treatment modality.
Results: More than half of patients showed World Federation of Neurological Societies grades IV-V on admission. Univariate analyses showed that advanced age, worse pre-onset mRS score, more severe neurologic status on admission, higher modified Fisher grade on admission computed tomography scans, and acute and chronic hydrocephalus were associated with poor outcomes. In contrast, administration of a phosphodiesterase type III inhibitor, cilostazol, was associated with good outcomes in both univariate (P = 0.036) and multivariate analyses (adjusted odds ratio, 0.305; 95% confidence interval, 0.097-0.955; P = 0.042). Propensity score matching analyses showed that patients treated with cilostazol had better outcomes (P = 0.016) with fewer incidences of delayed cerebral infarction (P = 0.008).
Conclusions: Even in patients with aSAH aged ≥75 years, cilostazol administration may lead to better outcomes by suppressing the development of delayed cerebral infarction.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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