Abstract
The preventive effect of the serine protease inhibitor FUT-175 (nafamostat mesilate), a potent inhibitor of the complement system, against vasospasm was evaluated in 34 high risk patients with thick and diffuse subarachnoid hemorrhage (SAH) demonstrated by computed tomography corresponding to Fisher group 3. All patients underwent surgery within 96 hours following SAH and received the thromboxane A2 synthetase inhibitor, OKY-046, as part of standard care. FUT-175 (40-160 mg/day) was administered during the initial 4 days following surgery. 455 patients treated without FUT-175 in the Nagasaki SAH Data Bank (non-FUT group) formed the control group. FUT-175 significantly decreased the incidence of symptomatic vasospasm in patients with severe neurological grade (Hunt and Hess grade 3, p < 0.02; Hunt and Hess grade 4, p < 0.02). The incidence of favorable outcome was 76.5% in the FUT group and 60.4% in the non-FUT group, but not statistically different. However, when patients of Hunt and Hess grade 5 were excluded, the FUT group had a significantly improved outcome (p < 0.05). This study suggests that FUT-175 has an additive effect to OKY-046 in preventing vasospasm in high risk patients with severe SAH.
Publication types
-
Clinical Trial
-
Comparative Study
-
Controlled Clinical Trial
MeSH terms
-
Aged
-
Aneurysm, Ruptured / complications
-
Benzamidines
-
Brain Damage, Chronic / prevention & control
-
Brain Ischemia / prevention & control
-
Drug Evaluation
-
Drug Synergism
-
Enzyme Inhibitors / administration & dosage
-
Enzyme Inhibitors / therapeutic use*
-
Female
-
Glasgow Coma Scale
-
Guanidines / administration & dosage
-
Guanidines / pharmacology
-
Guanidines / therapeutic use*
-
Humans
-
Intracranial Aneurysm / complications
-
Ischemic Attack, Transient / drug therapy
-
Ischemic Attack, Transient / etiology
-
Ischemic Attack, Transient / prevention & control*
-
Male
-
Methacrylates / administration & dosage
-
Methacrylates / pharmacology
-
Methacrylates / therapeutic use*
-
Middle Aged
-
Postoperative Complications / drug therapy
-
Postoperative Complications / etiology
-
Postoperative Complications / prevention & control*
-
Rupture, Spontaneous
-
Serine Proteinase Inhibitors / administration & dosage
-
Serine Proteinase Inhibitors / therapeutic use*
-
Severity of Illness Index
-
Subarachnoid Hemorrhage / complications*
-
Subarachnoid Hemorrhage / surgery
-
Thromboxane-A Synthase / antagonists & inhibitors*
-
Treatment Outcome
Substances
-
Benzamidines
-
Enzyme Inhibitors
-
Guanidines
-
Methacrylates
-
Serine Proteinase Inhibitors
-
Thromboxane-A Synthase
-
ozagrel
-
nafamostat