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Duration and choices of prophylactic anticonvulsants in subarachnoid hemorrhage: a systematic review and meta-analysis

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A Letter to the editor to this article was published on 21 April 2021

Abstract

The use of prophylactic anticonvulsants among patients with subarachnoid hemorrhage (SAH) is controversial. We sought to assess the effectiveness of different durations of prophylactic antiepileptic drug (AED) use among SAH patients. We searched the MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases until March 1, 2020. Randomized controlled trials or observational studies comparing different durations or different drugs were selected. The primary outcome was poor clinical outcomes. The secondary outcome was in-hospital seizure. Bayesian network meta-analysis was also performed to indirectly compare the effectiveness of different prophylaxes. A total of 5 papers were included. Three studies with a total of 959 patients were included in the analysis of the primary outcome; the results showed that long-term exposure to prophylactic AEDs (more than 3 days) led to poor clinical outcomes (OR 1.55; 95% CI 1.01–2.39; p = 0.045). Four studies with 1024 patients were included in the analysis of the secondary outcome; the results showed no association between the duration of prophylactic AED use and the occurrence of in-hospital seizures (OR 0.62; 95% CI 0.18–2.15; p = 0.447). In the network meta-analysis, no significant difference was found among the four different prophylaxes. Our findings suggested that, when compared with the short-term use, the long-term use of prophylactic AEDs in SAH patients has a similar effect on in-hospital seizure prevention but is associated with poor clinical outcomes. However, these findings were based on a small number of available studies with obvious heterogeneity in study design and different prescription regimens. Further well-designed studies are warranted to elucidate these questions.

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  1. Yuqi Chen, Fan Xia and Chengzhi Cai contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, People’s Republic of China

    Yuqi Chen, Fan Xia, Hao Li, Lu Ma, Xin Hu & Chao You

  2. Department of Thoracic Oncology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, People’s Republic of China

    Chengzhi Cai

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  1. Yuqi Chen
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Dr. Hu was the guarantor of the review.

Project design: Chen, Xia, and Hu; data collection: Chen, Xia, and Cai; manuscript drafting: Chen, Xia, and Cai; statistical analysis: Chen, Xia, and Cai; manuscript revision: Chen, Xia, Cai, Li, Ma, Hu, and You; supervision: Chen, Hu, and You

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Correspondence to Xin Hu.

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Chen, Y., Xia, F., Cai, C. et al. Duration and choices of prophylactic anticonvulsants in subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev 44, 2459–2467 (2021). https://doi.org/10.1007/s10143-020-01466-1

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