Abstract
The use of clazosentan in subarachnoid hemorrhage (SAH) complicated by takotsubo cardiomyopathy (TCM) has been avoided because of the side effects of pleural effusion and pulmonary edema. Based on our experience in treating six patients with SAH and TCM, we assessed the usefulness of perioperative management with clazosentan.
Of the 55 patients who underwent perioperative management with single-agent clazosentan at our hospital from June 2022 to March 2024, six who had complicated TCM at admission were included. Fluid delivery, chest radiography, electrocardiography, ejection fraction, and cardiac markers (NT-proBNP, creatinine kinase [CK] , CK-MB, and troponin T) from Days 0 to 14 were examined retrospectively.
Of the 55 patients who were administered clazosentan, six patients (10.9%) were diagnosed with TCM, as indicated by echocardiography upon admission, and three of these patients (5.5%) had congestive heart failure. Fluid management was maintained below＋500ml on Days 0-9. In those patients who presented with congestive heart failure, we frequently evaluated chest X-rays. Clazosentan was administered after the treatment for heart failure and hypotension. No adverse events were associated with clazosentan.
With strict control of TCM and appropriate fluid management, clazosentan may be safely administered to patients with SAH and TCM.
