Abstract
The preventive effect of nifedipine (Adalat^<(R)>) on delayed ischemic deterioration (DID) and angiographically detected vasospasms has been assessed in 72 patients presenting with grade 2 to 4 aneurysmal subarachnoid hemorrhage (SAH) on admission (Hunt and Kosnik classification). All patients underwent acute surgery within 72 hours after the SAH. For 44 patients, a sublingual administration of nifedipine (10 mg) was commenced immediately after the diagnosis of SAH and was continued every four hours for at least 14 days. Nifedipine treatment commenced on admission was found to be associated with a good prognosis for patients with a Grade 2 SAH classification and significantly lowered the occurrence of angiographically detected vasospasm and DID in comparison to a control group not given nifedipine treatment. Of 18 patients given nifedipine treatment, platelet aggregation, which was measured from 7 to 14 days after the SAH, decreased in 15 patients (83.3%), and DID was found to occur more frequently in patients showing an insufficient inhibition of platelet aggregability. Measurement of the nifedipine blood levels in 10 patients revealed that the nifedipine concentration peaked on the third day of treatment and then declined in all patients. In 2 patients manifesting DID, the nifedipine concentration showed the steep decrease after the third day of treatment. These results seem to indicate that nifedipine is effective in preventing angiographically detected vasospasms and DID, and that the inhibition of platelet aggregability may be involved in this preventive effect.
