AI Chat Paper
Note: Please note that the following content is generated by AMiner AI. SciOpen does not take any responsibility related to this content.
{{lang === 'zh_CN' ? '文章概述' : 'Summary'}}
{{lang === 'en_US' ? '中' : 'Eng'}}
Chat more with AI
Powered by AMiner. Clicking this button will take you away from SciOpen.
Home Brain Hemorrhages Article
PDF (347.3 KB)
Cite
EndNote(RIS) BibTeX
Collect
Submit Manuscript AI Chat Paper
Show Outline
Outline
Show full outline
Hide outline
Outline
Show full outline
Hide outline
Research Article | Open Access

Impact of strict fluid management on the treatment outcome of clazosentan for cerebral vasospasm

Takaaki Itazu, Taichi Ikedo( ), Takeyoshi Tsutsui, Akihiro Niwa, Yuji Kushi, Saya Ozaki, Naoto Yamada, Koji Shimonaga, Eika Hamano, Kiyofumi Yamada, Hirotoshi Imamura, Hisae Mori, Koji Iihara, Hiroharu Kataoka
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Show Author Information

Abstract

Objective

Clazosentan (CLA) reduces cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, adverse events including pulmonary edema were reported. We examined whether the strict management of fluid balance reduces the adverse events and improves patient outcomes.

Methods

Patients with aSAH between 2020 and 2023 were included. They were divided into pre-CLA (before CLA approval) and post-CLA (after approval) groups. The patients in the post-CLA group were further divided into the post-CLA1 (before the change in fluid management) and post-CLA2 (after the change) groups. To achieve fluid balance of 0–500 ml/day according to the modified protocol, the infusion volume was restricted.

Results

The daily fluid balance increased from the pre-CLA to the post-CLA1 periods (p = 0.01). The protocol changes decreased the pulmonary edema (post-CLA1 vs. post-CLA2, 44 vs. 22 %, p = 0.09) and discontinuation of CLA (44 vs. 9 %, p < 0.01). The incidence of symptomatic spasm (SS) and delayed cerebral infarction (DCI) in the post-CLA2 were slightly reduced without significant differences (SS: 17 vs. 13 %, p = 0.69; DCI: 11 vs. 9 %, p = 1.00).

Conclusion

Strict management of fluid balance during CLA treatment reduced the adverse events and discontinuation of CLA administration. Fluid restriction may positively affect the management of cerebral vasospasms.

Keywords

Subarachnoid hemorrhageClazosentanCerebral vasospasmPulmonary edemaFluid balance

References

1

Crowley RW, Medel R, Kassell NF, Dumont AS. New insights into the causes and therapy of cerebral vasospasm following subarachnoid hemorrhage. Drug Discov Today.. 2008;13(5–6):254–260.
Crossref Google Scholar
2

Oliveira JG, De J, Beck C, Ulrich J, Rathert A, Raabe V. Comparison between Clipping and Coiling on the Incidence of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Neurosurg Rev.. 2007;30(1):30–31.
Crossref Google Scholar
3

Davenport AP, Hyndman KA, Dhaun N, et al. Endothelin. Pharmacol Rev.. 2016;68(2):357–418.
Crossref Google Scholar
4

Endo H, Hagihara Y, Kimura N, et al. Effects of clazosentan on cerebral vasospasm-related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients. J Neurosurg.. 2022;137(6):1707–1717.
Crossref Google Scholar
5
Iglarz M, Pasquali A, Steiner P, Clozel M. Endothelial ETB Receptor Can Mediate Abnormal Vascular PermeabilityA51. Pulmonary vascular proliferation and permeability. American Thoracic Society International Conference Abstracts. American Thoracic Society; 2013:A1716–A.
6

Vercauteren M, Trensz F, Pasquali A, et al. Endothelin ETA Receptor Blockade, by Activating ETB Receptors, Increases Vascular Permeability and Induces Exaggerated Fluid Retention. J Pharmacol Exp Ther.. 2017;361(2):322–333.
Crossref Google Scholar
7

Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39(11):3015–3021.
Crossref Google Scholar
8

Macdonald RL, Higashida RT, Keller E, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol.. 2011;10(7):618–625.
Crossref Google Scholar
9

Cho SS, Kim SE, Kim HC, Kim WJ, Jeon JP. Clazosentan for Aneurysmal Subarachnoid Hemorrhage: An Updated Meta-Analysis with Trial Sequential Analysis. World Neurosurg.. 2019;123:418–424.e3.
Crossref Google Scholar
10

Roux S, Breu V, Giller T, et al. Ro 61–1790, a new hydrosoluble endothelin antagonist: general pharmacology and effects on experimental cerebral vasospasm. J Pharmacol Exp Ther.. 1997;283(3):1110–1118.
Google Scholar
11

Horinouchi T, Terada K, Higashi T, Miwa S. Endothelin receptor signaling: new insight into its regulatory mechanisms. J Pharmacol Sci.. 2013;123(2):85–101.
Crossref Google Scholar
12

Muraoka S, Asai T, Fukui T, et al. Real-world data of clazosentan in combination therapy for aneurysmal subarachnoid hemorrhage: a multicenter retrospective cohort study. Neurosurg Rev.. 2023;46(1):195.
Crossref Google Scholar
Brain Hemorrhages
Volume 5 Issue 2,
April 2024
Pages 69-73
DOI: 10.1016/j.hest.2023.12.001
Cite this article:
Itazu T, Ikedo T, Tsutsui T, et al. Impact of strict fluid management on the treatment outcome of clazosentan for cerebral vasospasm. Brain Hemorrhages, 2024, 5(2): 69-73. https://doi.org/10.1016/j.hest.2023.12.001

142

Views

1

Downloads

2

Crossref

1

Web of Science

1

Scopus

Altmetrics
Received: 19 October 2023
Revised: 26 November 2023
Accepted: 03 December 2023
Published: 07 December 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/).
Return