Clinical neuropharmacology · 2025
Safety and Outcomes of Valproic Acid in Subarachnoid Hemorrhage Patients: A Retrospective Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Cobler-Lichter Matthew J, Suchdev Kushak, Tatro Hayley, Cascone Ava, Yang Joanna, Weinberg Janice, Abdalkader Mohamad K, Dasenbrock Hormuzdiyar H, Ong Charlene J, Cervantes-Arslanian Anna, Greer David, Nguyen Thanh N, Daneshmand Ali, Chung David Y
Аннотация
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.
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.