Nimodipine administration routes’ role on Aneurysmal Subarachnoid Hemorrhage outcomes - A retrospective cohort study

Abstract

Aim of the study: To evaluate the role Nimodipine administration route (oral or feeding tube) in the outcome of vasospasm (at 7 and 21 days) in patients hospitalized with aneurysmal subarachnoid hemorrhage (SAH), in addition to analyzing the incidence of mortality in this population. Methods: The study has a retrospective cohort design, with data collected in a tertiary teaching hospital in Porto Alegre, Brazil. The period analyzed was January 2019 and January 2023. Patients over 18 years old, diagnosed with SAH and who underwent at least 7 days of hospitalized nimodipine treatment were included. Results: A total of 121 patients were included: 59 received nimodipine orally and 62 via nasoenteral tube. A potential impact of using the administration route (nasoenteral tube) was identified on the increase in the regression-adjusted incidence of vasospasm in 7 days (RR=2.35; 95% CI: 1.01 - 5.46), in 21 days (RR=2.40; 95% CI: 1.05 - 5.46) and also as a possible factor for regression-adjusted increased mortality (RR=5.74; 95% CI: 2.10 - 15.65). Conclusions: This is the first study in the Brazilian (or even Latin American) context, in which the impact of the nasoenteral route of administration of nimodipine on the outcomes of vasospasm and mortality in patients with SAH.These findings indicate factors to be considered in clinical practice for patient outcomes and demonstrate the need for further studies to correlate pharmacokinetics and clinical outcomes.