Prevention And Treatment Of Clazosentan For Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage :a Systematic Review

Objective:To systematically review the efficacy and safety of clazosentan for cerebral vasospasm after aneurysmal subarachnoid hemorrhage.Methods:We searched some electronic databases such as the Cochrane Library,Medline,Embase,CENTRAL,CBMdisc,CNKI,VIP,CMCA etc.and relevant journals such as Chinese Journal of Neurology,Journal of Clinical Neurology,Journal of Apoplexy and Nervous Diseases,Chinese Journal of Neuroimmunology and Neurology,Chinese Journal of Clinical Neurosciences etc.from 2000 to 2017 to collect all randomized controlled trials(RCTs)about clazosentan treating patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage.The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions and data were extracted by two reviewers independently.We made quantitative comprehensive analysis(meta-analysis),qualitative comprehensive analysis for the study results.In the quantitative comprehensive evaluation,fixed or random potency model was chosen according to the heterogeneity between the studies.Meta-analysis was conducted by The Cochrane Collaboration's RevMan 5.3software.Estimated the comprehensive evaluation index by 95% confidence interval,and made a=0.05 for the size of test.Results:Four RCTs involving 2161 cases were included.The results of meta-analysis showed: ? the clazosentan group was more effective in decreasing the incidence of vasospasm compared to the control group[RR=0.58,95%CI(0.48,0.71),P <0.00001];? the clazosentan group was more effective in decreasing the incidence of vasospasm-related cerebral infarction compared to the control group[RR= 0.79,95%CI(0.63,1.00),P=0.05];? the clazosentan group was more effective in decreasing the incidence of vasospasm-related delayed ischemic neurological deficits compared to the control group[RR=0.75,95%CI(0.62,0.91),P=0.004];(4)the clazosentan group was more effective in decreasing the incidence of vasospasm-related rescue therapy compared to the control group[RR= 0.68,95%CI(0.55,0.83),P=0.0002];(5)the clazosentan group increased the risk of pulmonary complications compared to the control group[RR=1.79,95%CI(1.52,2.11),P<0.00001];(6)the clazosentan group increased the risk of anemia compared to the control group[RR= 1.44,95%CI(1.17,1.78),P=0.0007];(7)the clazosentan group increased the risk of hypotension compared to the control group [RR=2.42,95%CI(1.69,3.45),P<0.00001].Conclusion:Clazosentan for cerebral vasospasm after aneurysmal subarachnoid hemorrhage can effectively reduce the incidence of the vasospasm,vasospasm-related cerebral infarction,vasospasm-related delayed ischemic neurological deficits and vasospasm-related rescue therapy,it shows a good total effectiveness;clazosentan may increase the risk of adverse reactions of pulmonary complications,hypotension and anemia,but the continuing use of clazosentan of us is not affected,and above adverse reactions are easy processed,meanwhile the serious adverse reactions are not reported,so it has better safety.As the literatures and patients included are less,and the use of clazosentan with different dosage etc,so the conclusions still need more strictly designed,larger-sample size randomized controlled trials to verify.