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Early management of aneurysmal subarachnoid hemorrhage

A report of the Cooperative Aneurysm Study

Harold P. Adams Jr., Neal F. Kassell, James C. Torner, Donald W. Nibbelink and Adolph L. Sahs

13 dead 50 28.7 35 57.4 85 36.2 * Of the 14 observations missing at 90 days, 11 were among initially good condition patients and three among initially poor condition patients. Mortality The mortality at 14 days was 6.5% (12) of the 185 initially good and 32.8% (21) of the 64 poor condition patients ( Table 4 ). The mortality at 90 days was 28.7% (50) of the 174 patients initially in good condition and 57.4% (35) of the 61 in poor condition ( Table 5 ). The mortality rate among the total group of

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Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage

Preliminary observations from the Cooperative Aneurysm Study

Neal F. Kassell, James C. Torner and Harold P. Adams Jr.

. Mortality Rate The overall mortality rate was essentially identical in both groups ( Fig. 5 and Table 3 ). The mortality rate at 14 days for the antifibrinolytic group was 13.2%, and at 30 days it was 22.3%. For the no-antifibrinolytic group, the mortality rate was 13.0% and 20.0%, respectively. In the no-antifibrinolytic group, the estimated cause of death at 30 days was rebleeding in 45% and vasospasm in 24%. The situation was almost identically reversed in those patients who did receive antifibrinolytic agents where the estimated cause of death was rebleeding in 24

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Neal F. Kassell, James C. Torner, John A. Jane, E. Clarke Haley Jr., Harold P. Adams and participants

used to detect a difference of 3% in the mortality rate between planned intervals to surgery at a power of 80% and a significance level of 0.05. At the time of completion of the initial admission examination, surgeons were required to specify at which time interval they planned to conduct surgery. The intervals which could be chosen included Days 0 to 3, Days 4 to 6, Days 7 to 10, Days 11 to 14, Days 15 to 32, and no surgery. Surgery, when and if it was conducted, was performed as required by the patient's clinical condition and neurological status. Data were

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Neal F. Kassell, James C. Torner, E. Clarke Haley Jr., John A. Jane, Harold P. Adams, Gail L. Kongable and Participants

.6 320 9.1 194 5.5 63 1.8 917 26.0 3521 100.0 * Percentages are of row totals. Relationship between admission level of consciousness and outcome: chi-square = 720.5; p < 0.001. The patient's age was inversely related to favorable outcome ( Table 16 ). Approximately 86% of patients between the ages of 18 and 29 years had a good result while only 26% of patients between the ages of 70 and 87 years had a similar outcome. The mortality rate of these two groups was 7% and 49%, respectively. The distribution of the Glasgow Outcome

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E. Clarke Haley Jr., Neal F. Kassell, James C. Torner and Participants

). Fifty-five percent of nicardipinetreated patients were rated as having a good recovery at 3 months versus 56% of placebo-treated patients. Twelve percent of each group were rated as being moderately disabled. The number of patients lost to follow-up monitoring, as well as the number followed for a mean of 3 months ± 30 days, was similar among the two groups. Mortality rates were also remarkably similar (17% dead at follow-up review in the nicardipine-treated group vs. 18% dead in the placebo-treated group) ( Fig. 4 ). The primary causes of death and disability were

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Giuseppe Lanzino, Neal F. Kassell, Teresa Germanson, Laura Truskowski and Wayne Alves

.0001). Mortality rates were 8.4% (nine of 107 patients) and 25.8% (54 of 209 patients), respectively (p = 0.0002). TABLE 3 Mean plasma glucose levels between Days 3 and 7 in relation to GOS score at 3 months in SAH patients * Outcome Normal Glucose Level † Elevated Glucose Level † p Value No. % No. % no. of cases 179 322 GOS score  good recovery 132 73.7 160 49.7 < 0.0001  moderate disability 13 7.3 44 13.7  severe disability 14 7.8 33 10

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E. Clarke Haley Jr., Neal F. Kassell, James C. Torner, Laura L. Truskowski, Teresa P. Germanson and the Participants

incidence of symptomatic vasospasm observed with either dose of nicardipine tested in this study (31% to 32%) is similar to the rate reported in the nicardipine group in the previous trial (31.6%), which was clearly lower than the rate reported in the placebo-treated group (45.5%). Of note is the finding that the mortality rate in both groups in the present study (11.5%) was better than that in the high-dose nicardipine group in the placebo-controlled trial (17%) (p < 0.01). As the patients appeared to be similar at baseline, the reasons for the apparent improvement in

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Phase II trial of tirilazad in aneurysmal subarachnoid hemorrhage

A report of the Cooperative Aneurysm Study

E. Clarke Haley Jr., Neal F. Kassell, Wayne M. Alves, Bryce K. A. Weir, Carolyn Apperson Hansen and Participants

Drug Administration. Although mortality rates were higher in the 6 mg/kg tirilazad-treated group, none of the deaths was reported to be study drug related, and the difference between the mortality rates in the 6 mg/kg tirilazad-treated group and the vehicle-treated group was not statistically significant, although a type II statistical error cannot be excluded. The U-shaped dose—response curve in the experimental models of SAH also influenced the decision to terminate the study after accrual to the third dosage tier was completed. Conclusions Tirilazad

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Richard S. Polin, Mark E. Shaffrey, Mary E. Jensen, Lisa Braden, Robert D. G. Ferguson, Jacques E. Dion and Neal F. Kassell

aneurysms, 40 of which were intercavernous. Perioperative care included low-molecular-weight dextran for 48 hours after the procedure and 24 hours of anticoagulation therapy in some patients. The researchers reported a 10% rate of transient ischemia following the procedure, with ischemia being reversible in these cases using volume expansion and anticoagulation therapy. They also noted a permanent ischemic morbidity rate of 5% and a mortality rate of 5%. Barnett and colleagues 2 have attempted to perform EC—IC artery bypass together with intraoperative carotid

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Giuseppe Lanzino, Neal F. Kassell, Teresa P. Germanson, Gail L. Kongable, Laura L. Truskowski, James C. Torner, John A. Jane and Participants

.001). Seventy-three percent of patients who were 40 years and younger made a good recovery. The percent of patients who made a good recovery then progressively decreased to 62%, 55%, 41%, and 25%, respectively, in the other advancing age groups considered. Mortality rates increased from 12% in the youngest age group to 35% in the oldest age group. The age-related differences in outcome were still present when the admission WFNS grade was also taken into account (p < 0.001, Cochran-Mantel-Haenzsel test) ( Table 6 ). TABLE 5 Outcomes at 3 months in 885 patients with