Effect of Clazosentan in Patients with Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis of Randomized Controlled Trials 英文参考文献.docVIP

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Effect of Clazosentan in Patients with Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis of Randomized Controlled Trials 英文参考文献.doc

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Effect of Clazosentan in Patients with Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis of Randomized Controlled Trials 英文参考文献

EffectofClazosentaninPatientswithAneurysmal SubarachnoidHemorrhage:AMeta-Analysisof RandomizedControlledTrials XiangWang1.,Yi-MingLi1.,Wei-QingLi2,Cheng-GuangHuang1*,Yi-ChengLu1,Li-JunHou1* 1Department of Neurosurgery, Second Military Medical University, Changzheng Hospital, Shanghai, China, 2Department of Pathology, Second Military Medical University,ChangzhengHospital,Shanghai,China Abstract Background: Cerebral vasospasmis themostimportant potentiallytreatable causeof mortality andmorbidity following aneurysmalsubarachnoidhemorrhage(aSAH).Clazosentan,aselectiveendothelinreceptorantagonist,hasbeensuggested tohelpreducetheincidenceofvasospasminpatientswithaSAH.However,theresultswerecontroversialinprevioustrials. Thismeta-analysisattemptstoassesstheeffectofclazosentaninpatientswithaSAH. Methodology/Principal Findings: We systematically searched Pubmed, Embase, and the Cochrane Library from their inceptionuntilJune,2012.Allrandomizedcontrolledtrials(RCTs)relatedtotheeffectofclazosentaninaSAHwereincluded. Theprimaryoutcomesincludedtheincidenceofangiographicvasospasm,newcerebralinfarction(NCI),delayedischemic neurological deficits (DIND), and vasospasm-related morbidity/mortality (M/M); the second outcomes included the occurrenceofrescuetherapy,all-cause-mortality,andpooroutcome.4RCTswereincludedwithatotalof2156patients. Theriskofangiographicvasospasm(relativerisk[RR]=0.58;95%CI,0.48to0.71),DIND(RR=0.76;95%CI,0.62to0.92),and vasospasm-related M/M(RR=0.80;95% CI,0.67to0.96)werestatisticallysignificantlyreducedintheclazosentangroup. Patientstreatedwithclazosentanhadareducedoccurrenceofrescuetherapy(RR=0.62;95%CI,0.49to0.79).However,no statistically significant effects were observed in NCI(RR=0.74;95% CI, 0.52 to1.04), mortality (RR=1.03; 95% CI,0.71 to 1.49),andpooroutcome(RR=1.12;95%CI,0.96to1.30). Conclusions/Significance:Ourpoolingdatasupportsthatclazosentanisprobablyeffectiveinpreventingtheoccurrenceof angiographic vasospasm, vasospasm-related DIND, vasospasm rel