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Magnesium and aspirin treatment in patients with subarachnoid haemorrhage

Comparison of effects after endovascular and neurosurgical aneurysm occlusion

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Abstract

Objective

Aneurysm treatment with endovascular coiling is associated with a better outcome than neurosurgical clipping in patients with subarachnoid haemorrhage (SAH). The better outcome after coiling may decrease the risk reduction from other treatments in these patients, and thus may increase sample sizes for current or future neuroprotective trials. The influence of the method of aneurysm treatment was studied in our randomised MASH trial, which assessed in a factorial design the efficacy of magnesium and aspirin in preventing delayed cerebral ischaemia (DCI) and poor outcome.

Methods

Between November 2000 and January 2004 315 patients were enrolled in the trial; 55 of them had no aneurysm treatment and were excluded for the current analysis, 176 underwent neurosurgical and 84 endovascular treatment. The effect of treatment on the risk of DCI was assessed by means of Cox proportional hazards modelling and that of poor outcome by means of logistic regression analysis.

Results

The hazard ratio of DCI with aspirin was 1.4 (95 % CI 0.3 – 1.7) after coiling and 1.9 (0.8 – 4.4) after clipping, and with magnesium 0.4 (0.1 – 1.2) after coiling and 0.8 (0.4 – 1.7) after clipping. The odds ratio of poor outcome with aspirin was 0.7 (0.2 – 2.9) after coiling and 0.8 (0.3 – 2.3) after clipping, and with magnesium 0.3 (0.1 – 1.0) after coiling and 0.8 (0.4 – 1.6) after clipping.

Conclusion

This post hoc analysis does not suggest that medical treatments are less effective after endovascular than after neurosurgical treatment in patients with SAH, and thus do not support a need for adjusting sample size calculations in future trials.

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Authors and Affiliations

  1. Dept. of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands

    W. M. van den Bergh MD, PhD, A. Algra & G. J. E. Rinkel

  2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    A. Algra

  3. Dept. of Intensive Care, Room Q04.460, University Medical Centre Utrecht, 85500, 3508 GA, Utrecht, The Netherlands

    W. M. van den Bergh MD, PhD

Authors
  1. W. M. van den Bergh MD, PhD
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  2. A. Algra
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  3. G. J. E. Rinkel
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on behalf of the MASH study group

Corresponding author

Correspondence to W. M. van den Bergh MD, PhD.

Additional information

Magnesium and Acetylsalicylic acid in Subarachnoid Haemorrhage (MASH) Study Group:

W. M. van den Bergh,A. Algra, S. M. Dorhout Mees,J. van Gijn,G. J. E. Rinkel,Dept. of Neurology,University Medical Centre Utrecht,Utrecht, The Netherlands

Ale Algra,Julius Centre for Health Sciences and Primary Care,University Medical Centre Utrecht,Utrecht, The Netherlands

Fop van Kooten,Dept. of Neurology,Erasmus Medical Centre,Rotterdam, The Netherlands

Clemens M.F. Dirven,Dept. of Neurology,VU University Medical Centre,Amsterdam, The Netherlands

Marinus Vermeulen,Dept. of Neurology,Academic Medical CentreUniversity of Amsterdam,Amsterdam, The Netherlands

W. M. van den Bergh, MD, PhD ✉, Dept. of Intensive Care, Room Q04.460,University Medical Centre Utrecht,P.O. Box 85500,3508 GA, Utrecht, The Netherlands,Tel.: +31-30/2508350,Fax: +31-30/2522782,E-Mail: w.m.vandenbergh@umcutrecht.nl

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van den Bergh, W.M., Algra, A., Rinkel, G.J.E. et al. Magnesium and aspirin treatment in patients with subarachnoid haemorrhage. J Neurol 256, 213–216 (2009). https://doi.org/10.1007/s00415-009-0057-5

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  • DOI: https://doi.org/10.1007/s00415-009-0057-5

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