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A multicentre observational study of the use of antiseizure medication in patients with aneurysmal subarachnoid haemorrhage in the PROMOTE-SAH study

  • Vanessa Carnegie
    Correspondence
    Corresponding author.
    Affiliations
    Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Sacha Schweikert
    Affiliations
    Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Matthew Anstey
    Affiliations
    Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Bradley Wibrow
    Affiliations
    Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Anthony Delaney
    Affiliations
    Royal North Shore Hospital, Sydney, New South Wales, Australia
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  • Oliver Flower
    Affiliations
    Royal North Shore Hospital, Sydney, New South Wales, Australia
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  • Jeremy Cohen
    Affiliations
    Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia
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  • Mark Finnis
    Affiliations
    Royal Adelaide Hospital, Adelaide, South Australia, Australia
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  • Andrew Udy
    Affiliations
    The Alfred Hospital, Melbourne, Victoria, Australia
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  • for the PROMOTE-SAH Investigators
    Author Footnotes
    1 A. Udy, D.J. Cooper, J. Board (The Alfred Hospital and Monash University, Melbourne, Victoria), R. Bellomo (The Austin Hospital and Monash University, Melbourne, Victoria), A. Delaney, E. Fitzgerald, O. Flower (Royal North Shore Hospital, Sydney, NSW), J. Anstey, D. Barge, V. Bhardwa (Royal Melbourne Hospital, Melbourne, Victoria), A. van der Poll, L. Newby (Auckland City Hospital, Auckland, NZ), E.P. Raith, M. Finnis (Royal Adelaide Hospital, Adelaide, SA), M. Anstey, S. Schweikert (Sir Charles Gairdner Hospital, Perth, WA), J. Cohen, T. Starr (Royal Brisbane and Women’s Hospital, Brisbane, Queensland), M. Tallott, D. Pearson (Gold Coast University Hospital), A. Hunt, P Young, Y. Robertson, C. Lawrence (Wellington Hospital, Wellington, NZ), P. Healey, G. Brinkerhoff (John Hunter Hospital, Newcastle, NSW), J. Mehrtens (Christchurch Hospital, Christchurch, NZ).
  • Author Footnotes
    1 A. Udy, D.J. Cooper, J. Board (The Alfred Hospital and Monash University, Melbourne, Victoria), R. Bellomo (The Austin Hospital and Monash University, Melbourne, Victoria), A. Delaney, E. Fitzgerald, O. Flower (Royal North Shore Hospital, Sydney, NSW), J. Anstey, D. Barge, V. Bhardwa (Royal Melbourne Hospital, Melbourne, Victoria), A. van der Poll, L. Newby (Auckland City Hospital, Auckland, NZ), E.P. Raith, M. Finnis (Royal Adelaide Hospital, Adelaide, SA), M. Anstey, S. Schweikert (Sir Charles Gairdner Hospital, Perth, WA), J. Cohen, T. Starr (Royal Brisbane and Women’s Hospital, Brisbane, Queensland), M. Tallott, D. Pearson (Gold Coast University Hospital), A. Hunt, P Young, Y. Robertson, C. Lawrence (Wellington Hospital, Wellington, NZ), P. Healey, G. Brinkerhoff (John Hunter Hospital, Newcastle, NSW), J. Mehrtens (Christchurch Hospital, Christchurch, NZ).
DOI:https://doi.org/10.1016/j.jocn.2022.06.022
A multicentre observational study of the use of antiseizure medication in patients with aneurysmal subarachnoid haemorrhage in the PROMOTE-SAH study
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      Highlights

      • •
        Seizures are a significant complication of aneurysmal subarachnoid haemorrhage.
      • •
        Antiseizure medication is often used in the prevention of seizures in subarachnoid haemorrhage.
      • •
        There is insufficient evidence to support recommendations concerning antiseizure medications in subarachnoid haemorrhage.
      • •
        Robust trial data are urgently needed to inform best practice guidelines.

      Abstract

      Our objective was to describe antiseizure medication (ASM) prescription patterns, and associations between ASM use and death and disability outcomes in patients with aneurysmal subarachnoid haemorrhage (aSAH) admitted to ICU. This was a multi-centre prospective observational study. The study took place in eleven ICUs across Australia and New Zealand. Data was collected from 1 April 2017 to 1 October 2018. Three hundred and fifty-seven adult patients with aSAH were enrolled. The primary outcome was to describe patterns of ASM prescription. The secondary outcome of interest was death or disability (modified Rankin Scale (mRS) score ≥ 4) at six months, and its association with ASM therapy, and relevant clinical subgroups. Forty percent of patients received an ASM and the most commonly used agent was levetiracetam. The median length of ASM administration was eight days (IQR 4.5–12.5). A number of patients with prehospital seizures did not receive ASM therapy (14/55, 2725%). There was a tendency towards ASM prescription with both higher radiological and clinical grade aSAH. There was no significant association between death or disability at six month (mRS ≥ 4) and ASM vs No ASM prescription. Testing for an interaction effect between ASM administration and WFNS grade suggested inferior outcomes with ASM use in lower aSAH grades (p = 0.04). In conclusion, the prescription of ASM for aSAH in Australia is variable across and within sites, with the majority of patients not receiving ASM chemoprophylaxis. We demonstrated no significant association between death or disability at six months and the use of ASM. There may be an association with poorer outcomes in patients with lower grade aSAH. This finding requires further exploration.

      Keywords

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      Article info

      Publication history

      Accepted: June 27, 2022
      Received: October 25, 2021

      Identification

      DOI: https://doi.org/10.1016/j.jocn.2022.06.022

      Copyright

      Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.

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