May 29, 2012

Magnesium Debate for Preventing Stroke

(Ivanhoe Newswire) -- There has been controversy over the effectiveness of magnesium treatment for preventing poor outcomes in those who have had a hemorrhagic stroke. After an international randomized trial and meta-analysis, the controversy could end.

"Intravenous magnesium does not affect outcome after aneurysmal subarachnoid hemorrhage. Subgroup analyses did not identify a subgroup of patients who might benefit from magnesium treatment“¦therefore routine administration of magnesium cannot be recommended," the study authors were quoted as saying.

Around a third of patients with aneurysmal subarachnoid hemorrhage (SAH; the bursting of a blood vessel on the surface of the brain), the deadliest form of stroke, will die within the first month. 20% of those that survive are left disabled. One of the important causes of poor outcome, delayed cerebral ischemia, can occur 4 to 10 days after SAH.

Although there were promising findings from earlier research, recent studies report conflicting results.

In a randomized trial comparing magnesium treatment (606 patients) with a saline placebo (597 patients) conducted in adults with SAH from the Netherlands, Scotland, and Chile, no difference in poor outcome was measured on the modified Rankin Scale between the groups at 3 months. 158 patients (26.2%) given magnesium compared with 151 (25.3%) given placebo had poor outcome.

A further meta-analysis of seven randomized trials that analyzed over 2000 SAH patients also found that magnesium was not superior to placebo.

"The results, although disappointing, are nonetheless very pertinent to the management of patients with aneurysmal subarachnoid hemorrhage. We agree with the researchers, and previous findings, that routine intravenous magnesium sulphate infusion cannot be recommended for patients with aneurysmal subarachnoid hemorrhage," Chethan Venkatasubba Rao and Jose Suarez from Baylor College of Medicine, Texas, USA, were quoted as saying.

SOURCE: Lancet, May 2012