Abstract Details

After aSAH patients are given CCB to prevent vasospasm which is associated with worsened outcomes.

It remains unclear how the timing of in-hospital calcium channel blockers (CCBs; Nimodipine or Cardene) initiation effects the risk for vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).

This retrospective cohort study included adults (≥ 18) with aSAH at a Comprehensive Stroke Center (1/18-11/21) who were taking the following prehospital antihypertensives: CCBs, Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor blockers (ARBs). Comparisons were made between those who received vasospasm prevention (‘in-hospital CCBs’) ≤ 1 hour of arrival to those who received in-hospital CCBs > 1 hour from arrival.  Outcomes included: vasospasm, length of stay (LOS), and death.

There were 252 patients, 18% were taking prehospital antihypertensives. Of those 80% received in-hospital CCBs: 35% ≤ 1 hour of arrival, 65% received them > 1 hour of arrival. Patients were similar in their baseline characteristics. The time to in-hospital CCBs was significantly longer for patients who had a vasospasm, 1.3 vs 5.2 h, p=0.02. Those who received in-hospital CCBs ≤ 1 hour of arrival experienced a significantly lower vasospasm rate (0% vs. 38%, p=0.01), LOS (11 vs 22, p=0.006), and death rate (0% vs 38%, p=0.01) than among those who did not. These results were not replicated for patients who were not on prehospital antihypertensives; the timing to in-hospital CCB initiation had no effect on vasospasm (p=0.18), death (p=0.28), or LOS (p=0.08) for patients not on prehospital antihypertensives.

While larger studies are needed, this study showed that those on prehospital CCBs, ACE-inhibitors, or ARBs, receipt of in-hospital CCBs ≤ 1 hour of arrival significantly reduced the vasospasm rate, HLOS, and death rate. Reducing disruption times in prehospital antihypertensive treatment through in-hospital CCB receipt ≤ 1 hour of arrival, may prevent worsened outcomes.