Cilostazol administration with combination enteral and parenteral nutrition therapy remarkably improves outcome after subarachnoid hemorrhage

Abstract

Objective : In order to prevent cerebral vasospasm (VS) following aneurysmal subarachnoid hemorrhage (SAH), we introduced combined enteral nutrition (EN) and parenteral nutrition (PN) with oral cilostazol administration to the postoperative patient after SAH and investigated the effect on VS. Methods : After aneurysmal SAH, 130 postoperative patients were enrolled in this study between April 2008 and March 2012. The patients enrolled before April 2010 were treated by conventional therapy (control group). The patients enrolled after April 2010 were administrated cilostazol 200 mg/day and received EN and PN simultaneously (combined group). Results : The combined group consisted of 62 patients and the control group of 68 patients. Angiographic VS occurred in 33.9 % (n = 21) of the combined group and in 51.5 % (n = 35) of the control group (p = 0.051, Fisher exact test). The incidence of symptomatic VS was signifi cantly lower in the combined group (p = 0.001). The incidence of new cerebral infarctions was also signifi cantly lower in the combined group (p = 0.0006). Clinical outcome at discharge was also signifi cantly better in the combined group than in control group (p = 0.031). Conclusions : Cilostazol administration with combination EN and PN is remarkably effective in preventing cerebral VS after aneurysmal SAH.