Early Magnesium Treatment after Aneurysmal Subarachnoid Hemorrhage : Individual Patient Data Meta-Analysis

Background and Purpose— Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting Methods— Patients were divided into categories according to the delay between symptom onset and start of the study medication: 24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. Results— We included 5 trials totaling 1981 patients; 83 patients started treatment 24 hours 1.06 (0.87–1.31), and for DCI, 24 hours 1.08 (0.88–1.32). Conclusions— This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.