Evidence-based pharmacotherapy for cerebral vasospasm.
BACKGROUND
The vast amount of literature on the pharmaceutical treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage remains daunting. Optimal treatment regimens for patients can be obscured by studies not statistically powered to draw evidenced-based conclusions.


METHODS
In this chapter, we reviewed the English literature using the National Library of Medicine for studies regarding pharmacotherapies for the treatment of cerebral vasospasm. These studies were then categorized according to the US Preventative Services Task Force ranking system for evidence based medicine and reviewed each pharmacotherapy for its efficacy in the treatment of cerebral vasospasm.


RESULTS
Nimodipine (Nimotop), HMG Co-A reductase inhibitor (statins) and enoxaparin (Lovenox) were the only drugs with level-1 evidence available for the treatment of vasospasm from aneurysmal subarachnoid hemorrhage as defined by the US Preventative Services Task Force.


CONCLUSIONS
As the understanding of the pathophysiological mechanisms of vasospasm after aneurysmal subarachnoid hemorrhage evolves in the basic science laboratory, novel medications are being trialed in humans. However, significantly more work must be carried out in this area before we have an effective medical treatment that can prevent or reverse the devastating events of cerebral vasospasm.
Deshaies
Eric Michael
EM
Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY, USA. deshaiee@upstate.edu
Boulos
Alan S
AS
Drazin
Doniel
D
Popp
A John
AJ
D000818:Animals; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017984:Enoxaparin / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009553:Nimodipine / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D020301:Vasospasm, Intracranial / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*
D002317:Cardiovascular Agents; D017984:Enoxaparin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009553:Nimodipine