title: Acute systemic erythropoietin therapy to reduce delayed ischemic deficits following aneurysmal subarachnoid hemorrhage: a Phase II randomized, double-blind, placebo-controlled trial. Clinical article.
abstract: OBJECTIVE
  Delayed ischemic deficits (DIDs), a major source of disability following aneurysmal subarachnoid hemorrhage (aSAH), are usually associated with severe cerebral vasospasm and impaired autoregulation. Systemic erythropoietin (EPO) therapy has been demonstrated to have neuroprotective properties acting via EPO receptors on cerebrovascular endothelia and ischemic neurons. In this trial, the authors explored the potential neuroprotective effects of acute EPO therapy following aSAH.
  
  
  METHODS
  Within 72 hours of aSAH, 80 patients (age range 24-82 years) were randomized to receive intravenous EPO (30,000 U) or placebo every 48 hours for a total of 90,000 U. Primary end points were the incidence, duration, and severity of vasospasm and impaired autoregulation on transcranial Doppler ultrasonography. Secondary end points were incidence of DIDs and outcome at discharge and at 6 months.
  
  
  RESULTS
  Randomization characteristics were balanced except for age, with the EPO group being older (mean age 59.6 vs 53.3 years, p=0.034). No differences were demonstrated in the incidence of vasospasm and adverse events; however, patients receiving EPO had a decreased incidence of severe vasospasm from 27.5 to 7.5% (p=0.037), reduced DIDs with new cerebral infarcts from 40.0 to 7.5% (p=0.001), a shortened duration of impaired autoregulation (ipsilateral side, p<0.001), and more favorable outcome at discharge (favorable Glasgow Outcome Scale score, p=0.039). Among the 71 survivors, the EPO group had fewer deficits measured with National Institutes of Health Stroke Scale (median Score 2 vs 6, p=0.008).
  
  
  CONCLUSIONS
  This preliminary study showed that EPO seemed to reduce delayed cerebral ischemia following aSAH via decreasing severity of vasospasm and shortening impaired autoregulation.
authors.affiliation: Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, UK.
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Tseng
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: Hugh K
authors.initials: HK
authors.lastname: Richards
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.forename: John D
authors.initials: JD
authors.lastname: Pickard
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Erber
authors.forename: Stephen
authors.initials: S
authors.lastname: Brown
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kirkpatrick