Association between Preventive Administration of Fasudil Hydrochloride and Post-interventional Neurological Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage

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  • Matsui Hiroki
    Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo
  • Funakoshi Hiraku
    Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center
  • Yasunaga Hideo
    Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo
  • Fushimi Kiyohide
    Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine

Bibliographic Information

Published
2020
DOI
  • 10.37737/ace.2.4_107
Publisher
Society for Clinical Epidemiology

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<p>BACKGROUND</p><p>Cerebral vasospasm (CVS) occurs in 17% to 40% of patients with aneurysmal subarachnoid hemorrhage (aSAH). Various measures have been implemented to prevent CVS, including fasudil hydrochloride. However, data are lacking on the preventive effect of fasudil hydrochloride on CVS. The present study was performed to examine the association between postprocedural early administration of fasudil hydrochloride and outcomes in patients undergoing treatments for aSAH using a national inpatient database in Japan.</p><p>METHODS</p><p>Patients aged ≥18 years who were admitted because of aSAH from July 2010 to March 2014 and underwent clipping surgery or intravascular coil embolization within 72 hours from admission were eligible. We defined preventive fasudil hydrochloride as that administered within 1 day after the intervention. The outcomes were 30-day in-hospital mortality and the modified Rankin scale (mRS) score at discharge. We used instrumental variable methods to analyze the differences in the risk of these outcomes between patients with and without preventive fasudil hydrochloride.</p><p>RESULTS</p><p>Of 23,843 eligible patients, 77.1% received preventive fasudil hydrochloride. The overall 30-day in-hospital mortality rate was 2.2%, and the proportion of a good neurological outcome (mRS score of ≤2) was 65.0%. Instrumental variable analyses showed no significant difference in 30-day in-hospital mortality (risk difference, −1.8%; 95% confidence interval, −3.8% to 2.0%), but demonstrated a significant difference in an mRS score of ≤2 at discharge (risk difference, 7.8%; 95% confidence interval, 3.4% to 12.3%).</p><p>CONCLUSION</p><p>Early administration of fasudil hydrochloride after treatment for aSAH could be associated with a better neurological outcome at discharge.</p>

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