Preventive therapy against delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage: trials of thromboxane A2 synthetase inhibitor and hyperdynamic therapy.

Abstract

The effects of thromboxane A2 synthetase inhibitor and hyperdynamic therapy on delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage were evaluated in a series of twenty eight patients, who underwent aneurysmal clipping with 72 hours after subarachnoid haemorrhage. Postoperatively, 13 patients were treated with thromboxane A2 synthetase inhibitor, Xanbon [sodium (E)-3-[p-(1H-imidazol-1-ylmethyl)phenyl]-2-propenoate]. Hyperdynamic therapy with dobutamine was given to the remaining 15 patients. Of the 13 patients treated with Xanbon, nine patients (69%) developed delayed cerebral ischaemia and cerebral infarcts occurred in eight patients (62%). On the other hand, of the 15 patients treated with hyperdynamic therapy, only three patients (20%) manifested delayed cerebral ischaemia and two patients (13%) developed cerebral infarcts. In the present study, the patients treated with hyperdynamic therapy met an expected incidence of ischaemic events after subarachnoid haemorrhage by today's standards, while those treated with thromboxane A2 synthetase inhibitor did not.