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Research Article | Open Access

Fluid balance management with loop diuretics in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: A case series

Yosuke Akamatsua,b( ), Kohei Chidaa, Kenya Miyoshib, Daigo Kojimab, Jun-Ichi Nomuraa, Kengo Settaa, Takayuki Chibaa, Takahiro Kojia, Shunrou Fujiwaraa, Hiroshi Kashimurab, Yoshitaka Kuboa, Kuniaki Ogasawaraa
Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan
Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
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Abstract

Objective

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.

Methods

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).

Results

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.

Conclusion

Thus, proper management of fluid balance with clazosentan and diuretics would help in effective clazosentan therapy for vasospasm prophylaxis.

Keywords

Symptomatic vasospasmClazosentanAneurysmal subarachnoid hemorrhage

References

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Brain Hemorrhages
Volume 5 Issue 2,
April 2024
Pages 74-78
DOI: 10.1016/j.hest.2023.10.003
Cite this article:
Akamatsu Y, Chida K, Miyoshi K, et al. Fluid balance management with loop diuretics in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: A case series. Brain Hemorrhages, 2024, 5(2): 74-78. https://doi.org/10.1016/j.hest.2023.10.003

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Received: 20 September 2023
Revised: 05 October 2023
Accepted: 14 October 2023
Published: 16 October 2023
© 2023 International Hemorrhagic Stroke Association.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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