Safety and Outcomes of Valproic Acid in Subarachnoid Hemorrhage Patients: A Retrospective Study.

IF 0.8 4区医学 Q4 CLINICAL NEUROLOGY

Clinical Neuropharmacology Pub Date : 2025-03-01 Epub Date: 2025-02-19 DOI:10.1097/WNF.0000000000000627

Matthew J Cobler-Lichter, Kushak Suchdev, Hayley Tatro, Ava Cascone, Joanna Yang, Janice Weinberg, Mohamad K Abdalkader, Hormuzdiyar H Dasenbrock, Charlene J Ong, Anna Cervantes-Arslanian, David Greer, Thanh N Nguyen, Ali Daneshmand, David Y Chung

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引用次数: 0

Abstract

Objectives: Animal studies have suggested that valproic acid (VPA) is neuroprotective in aneurysmal subarachnoid hemorrhage (SAH). However, the effect of VPA on SAH outcomes in humans has not been investigated.

Methods: We conducted a retrospective analysis of 123 patients with nontraumatic SAH. Eighty-seven patients had an aneurysmal source and 36 patients had no culprit lesion identified. We used stepwise logistic regression to determine the association between VPA and delayed cerebral ischemia (DCI), radiographic vasospasm, and discharge modified Rankin Scale (mRS) score >3.

Results: All 18 patients who received VPA underwent coil embolization of their aneurysm. VPA use did not have a significant association with DCI on adjusted analysis (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 0.20-5.80). The association between VPA use and vasospasm was OR = 0.64 (0.19-1.98) and discharge mRS > 3 was OR = 0.45 (0.10-1.64). Increased age (OR = 1.04, 1.01-1.07) and Hunt and Hess grade >3 (OR = 14.5, 4.31-48.6) were associated with poor discharge outcome (mRS > 3). Younger age (OR = 0.96, 0.93-0.99), modified Fisher Scale (mFS) score = 4 (OR = 4.14, 1.81-9.45), and Hunt and Hess grade >3 (OR = 2.92, 1.11-7.69) were all associated with development of radiographic vasospasm. There were no complications associated with VPA administration.

Conclusions: We did not observe an association between VPA and the rate of DCI. We found that VPA use was safe in SAH patients who have undergone endovascular treatment of their aneurysm.

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丙戊酸治疗蛛网膜下腔出血患者的安全性和预后：一项回顾性研究。

目的：动物实验表明丙戊酸（VPA）对动脉瘤性蛛网膜下腔出血（SAH）具有神经保护作用。然而，VPA对人类SAH结果的影响尚未被研究。方法：我们对123例非创伤性SAH患者进行回顾性分析。87例患者有动脉瘤源，36例患者未发现罪魁祸首病变。我们采用逐步logistic回归来确定VPA与延迟性脑缺血（DCI）、影像学血管痉挛和放电修正Rankin量表（mRS）评分>.3之间的关系。结果：18例接受VPA的患者均行动脉瘤线圈栓塞术。经校正分析，VPA的使用与DCI无显著相关（优势比[OR] = 1.07, 95%可信区间[CI]: 0.20-5.80）。VPA使用与血管痉挛的相关性OR = 0.64 (0.19-1.98)， mRS bbbb3放电的相关性OR = 0.45（0.10-1.64）。年龄增加（OR = 1.04, 1.01-1.07）和Hunt and Hess分级bbb3 （OR = 14.5, 4.31-48.6）与不良放血结局（mRS >3）相关。年龄较小（OR = 0.96, 0.93-0.99）、修改Fisher量表（mFS）评分= 4 （OR = 4.14, 1.81-9.45）、Hunt and Hess分级>3 （OR = 2.92, 1.11-7.69）均与影像学血管痉挛的发生相关。没有与VPA相关的并发症。结论：我们没有观察到VPA和DCI发生率之间的关联。我们发现血管内治疗动脉瘤的SAH患者使用VPA是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neuropharmacology 医学-临床神经学

CiteScore

1.20

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Clinical Neuropharmacology is a peer-reviewed journal devoted to the pharmacology of the nervous system in its broadest sense. Coverage ranges from such basic aspects as mechanisms of action, structure-activity relationships, and drug metabolism and pharmacokinetics, to practical clinical problems such as drug interactions, drug toxicity, and therapy for specific syndromes and symptoms. The journal publishes original articles and brief reports, invited and submitted reviews, and letters to the editor. A regular feature is the Patient Management Series: in-depth case presentations with clinical questions and answers.