Volume 3 Supplement 1
Early magnesium treatment after aneurysmal subarachnoid hemorrhage: an individual patient data meta-analysis
- WM van den Bergh1 and
- writing groups of MASH-I, IMASH, MASH-II, MASH and FAST-MAG
© van den Bergh et al.; 2015
Published: 1 October 2015
Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials on magnesium treatment starting < 4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier instalment of treatment might be more effective, but individual trials had not enough power for such a sub-analysis.
We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH.
Patients were divided into categories according to the delay between symptom onset and start of the study medication: < 6 hours, 6-12 hours, 12-24 hours, > 24 hours. We calculated adjusted risk ratios (aRR) with corresponding 95% confidence intervals (CI) for magnesium versus placebo treatment for poor outcome and DCI.
We included 5 trials totalling 1981 patients, 83 patients started treatment < 6 hours. For poor outcome the aRRs of magnesium treatment for start < 6 hours were 1.44 (95%CI:0.83-2.51); for 6-12 hours 1.03(0.65-1.63), for 12-24 hours 0.84(0.65-1.09) and for >24 hours 1.06(0.87-1.31), and for DCI, < 6 hours 1.76(0.68-4.58), for 6-12 hours 2.09(0.99-4.39), for 12-24 hours 0.80(0.56-1.16) and for > 24 hours 1.08(0.88-1.32).
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.