The effects of nimopidine on platelet aggregation in severe head injury
Severe head injury (SHI) is often associated with traumatic subarachnoid haemorrhage (tSAH), vasospasm, and results in an unfavorable outcome. The aim of this study was to evaluate the effect of nimodipine on platelet aggregation in SHI.
This prospective study consisted of 80 patients (53 male, 27 female; ages ranging from 17 years to 65 years, mean: 36.2 years) with severe head injury (Glasgow Coma Score, GCS ≤8). All patients received antioedema therapy and prophylactic anticonvulsant. The patients were randomly assigned to either the nimodipine group (2 mg=h continuous infusion for one week) (n=45) or the control group (n=35). There were 13 patients with tSAH in the nimodipine group and 10 patients with tSAH in the control group. The platelet aggregation ratio (PAR) was measured on the initial day and the 7th day. Higher PAR indicates lower circulating platelet aggregates.
The two groups were well matched for age, sex, mode of injury, neurological status and CT scan findings. In fact, comparison of PAR and GCS in the two treatment groups revealed no difference on the first day. Compared to initial values, the nimodipine group showed a significantly higher PAR value (0.6 ± 0.1 vs. 0.9 ± 0.2, p<0.001) and mean GCS value (7.4 ± 0.7 vs. 13.7 ± 1.0, p<0.001) on the 7th day. As a result, on the 7th day, the nimodipine group had a significantly higher PAR values (0.7 ± 0.1 vs. 0.9 ± 0.2, p<0.001) and mean GCS (12.3 ± 1.3 vs. 13.7 ± 1.0, p<0.001) as compared to the control group. When the analyses were repeated for the subgroups (the patients with tSAH or contusion) nimodipine showed the same effectiveness.
Nimodipine effectively inhibits platelet hyperaggregability in severe head injury patients with or without traumatic subarachnoid haemorrhage. Thus, it may have a potential for use in these patients. However, its effect on long-term outcomes such as death and disability rates and quality of life is still to be determined.
KeywordsNimodipine platelet aggregation severe head injury vasospasm
Unable to display preview. Download preview PDF.
- 9.European Study Group on Nimodipine in Severe Head Injury (1994) A multicentre trial of the efficacy of nimodipine an outcome after severe head injury. J Neurosurg 80: 797–804Google Scholar
- 10.Fleckenstein-Grün G, Fleckenstein A (1990) Prevention of cerebrovascular spasms with nimodipine. Stroke 21: 64–71Google Scholar
- 16.Langham J, Goldfrad C, Teasdale G, Shaw D, Rowan K (2003) Calcium channel blockers for acute traumatic brain injury. Cochrane Database Syst Rev 4: CD000565Google Scholar
- 24.Suzuki S, Ohkuma H, Iwabuchi T, Yoshimura N (1988) Cerebral microthrombosis, synthesis imbalance of TXA2-PGI2 and subarachnoid focal asidosis in the pathogenesis of symptomatic cerebral vasospasm. In: Suzuki J (ed) Advances in surgery for cerebral stroke. Spring Verlag, Wien New York, pp 405–409Google Scholar
- 25.Teasdale G, Bailey I, Bell A, Gray J, Gullan R, Heiskanan O, Marks PV, Marsh H, Mendelow DA, Murray G (1992) A randomized trial of nimodipine in severe head injury: HIT I British/Finnish cooperative head injury trial group. J Neurotrauma 9: 545–550Google Scholar