title: Cilostazol administration with combination enteral and parenteral nutrition therapy remarkably improves outcome after subarachnoid hemorrhage.
abstract: OBJECTIVE
  In order to prevent cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH), we introduced combined enteral nutrition (EN) and parenteral nutrition (PN) with oral cilostazol administration to the postoperative patient after SAH and investigated the effect on VS.
  
  
  METHODS
  After aneurysmal SAH, 130 postoperative patients were enrolled in this study between April 2008 and March 2012. The patients enrolled before April 2010 were treated by conventional therapy (control group). The patients enrolled after April 2010 were administrated cilostazol 200 mg/day and received EN and PN simultaneously (combined group).
  
  
  RESULTS
  The combined group consisted of 62 patients and the control group of 68 patients. Angiographic VS occurred in 33.9 % (n = 21) of the combined group and in 51.5 % (n = 35) of the control group (p = 0.051, Fisher exact test). The incidence of symptomatic VS was significantly lower in the combined group (p = 0.001). The incidence of new cerebral infarctions was also significantly lower in the combined group (p = 0.0006). Clinical outcome at discharge was also significantly better in the combined group than in control group (p = 0.031).
  
  
  CONCLUSIONS
  Cilostazol administration with combination EN and PN is remarkably effective in preventing cerebral VS after aneurysmal SAH.
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusuniki-cho, Chuo-ku, Kobe, 650-0017, Japan, hkimura@med.kobe-u.ac.jp.
authors.forename: Hidehito
authors.initials: H
authors.lastname: Kimura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okamura
authors.forename: Yosiyuki
authors.initials: Y
authors.lastname: Chiba
authors.forename: Miyake
authors.initials: M
authors.lastname: Shigeru
authors.forename: Taiji
authors.initials: T
authors.lastname: Ishii
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hori
authors.forename: Ryoji
authors.initials: R
authors.lastname: Shiomi
authors.forename: Yuusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Maeyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000368:Aged; D000077407:Cilostazol; D003131:Combined Modality Therapy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period; D013345:Subarachnoid Hemorrhage / Q000178:diet therapy / Q000188:drug therapy / Q000601:surgery; D013777:Tetrazoles / Q000008:administration & dosage*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000517:prevention & control*
chemical_list: D018696:Neuroprotective Agents; D013777:Tetrazoles; D000077407:Cilostazol