Nimodipine in traumatic subarachnoid haemorrhage: A re-analysis of the HIT I and HIT II trials

GD Murray*, GM Teasdale, H Schmitz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Two large randomised controlled trials have been performed to study the effect of the calcium antagonist nimodipine on the outcome of severe head injury, HIT I [1] amd HIT II [4]. Both trials showed a modest and statistically non-significant increase in the proportion of favourable outcomes in patients treated with nimodipine. A subgroup analysis of the HIT II trial [4, 5] suggested, however, that there could be a substantial protective effect of nimodipine in patients with traumatic subarachnoid haemorrhage (SAH). This report provides a re-analysis of the HIT I data to see whether it provides confirmatory evidence of the subgroup effect observed in HIT II, This involved performing a central review of the CT scans for the HIT I patients, to identify those individuals with evidence of traumatic SAH. The sample size was small, but the HIT I data gave no support to the hypothesis that nimodipine is protective in the traumatic SAH subgroup, where 69% of patients had a poor outcome on placebo and 74% of patients had a poor outcome on nimodipine. The data do not exclude the possibility of a clinically relevant beneficial effect of nimodipine in the traumatic SAH subgroup, but further data are required to provide a definitive answer.

In addition, we present a pooled analysis of the data from the two trials, which suggests that the overall benefit of treating unselected head injured patients with nimodipine is unlikely to be clinically relevant.

Original languageEnglish
Pages (from-to)1163-1167
Number of pages5
JournalActa Neurochirurgica
Volume138
Issue number10
Publication statusPublished - 1996

Keywords

  • nimodipine
  • overview
  • severe head injury
  • subgroup analysis
  • traumatic subarachnoid haemorrhage
  • HEAD-INJURY
  • ANGIOGRAPHIC FINDINGS
  • HEMORRHAGE
  • BLOOD
  • SPASM

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