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EFFICACY OF INTRAVENOUS MILRINONE VERSUS INTRA ARTERIAL NIMODIPINE IN THE MANAGEMENT OF CLINICAL VASOSPASM SECONDARY TO ANEURYSMAL SUB ARACHNOID HEMORRHAGE
Background and Aims
Vasospasm causes significant morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH) patients. Hypertension, hemodilution, and hypervolemia (HHH therapy) have been tried in the past. Nimodipine has proved to be effective. Intra-arterial (IA) nimodipine is commonly used in the management of vasospasm along with supportive treatment. It is invasive, requires repeated sessions, associated with reflux vasospasm. Intravenous (IV) milrinone is also reported in the literature as an effective drug for the management of vasospasm. In this study, we observed the efficacy of IV milrinone versus IA nimodipine in the management of clinical vasospasm secondary to aneurysmal subarachnoid hemorrhage.
A total of 105 patients with clinical vasospasm was observed from January 2017 to March 2019. Sixty-five patients were reviewed retrospectively who underwent IA nimodipine therapy while 40 patients were reviewed prospectively who received continuous IV milrinone infusion.
65 and 40 patients in IA nimodipine and IV milrinone protocols, respectively. Clinical response was comparable between 2 cohorts: 55.38% (95%con_dence interval [CI], 43% - 67 %) in the IAN versus 52.5 % (95% CI, 37%- 67.9 %) in IVM group (p=0.773). . Multiple logistic analysis showed that nimodipine or milrinone use was an independent factor for the treatment of vasospasm (OR 0.96, 95% CI 0.38-2.38, p = 0.773). The favorable clinical outcome mRS 0-2 at 3 months was 58% in IAN and 70% in the IVM cohort with p value=0.373.
No significant difference in the clinical responses and neurological outcomes in IAN or IVM treatment protocols was seen.