Clinical Scorecard: Impact of Intravenous Human Albumin, Enteral Cilostazol, and Their Combined Use on Alleviating Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients

At a Glance

Key Highlights

• Cilostazol showed a median absolute risk reduction of 18.1 percentage points for DCI.
• Albumin demonstrated a median absolute risk reduction of 9.1 percentage points.
• Combination therapy had the largest projected reduction of 21.7 percentage points.
• Incremental benefit of adding albumin to cilostazol was small and uncertain.
• The findings support continued randomized evaluation of cilostazol and albumin.

Guideline-Based Recommendations

Diagnosis

• Use NINDS CDE-defined DCI (CDE-d-DCI) for diagnosis.

Management

• Consider enteral cilostazol and intravenous human albumin as candidate therapies.

Monitoring & Follow-up

• Monitor for new cerebral infarction on CT at approximately 2 weeks post-treatment.

Risks

• DCI remains a major cause of death and disability in aSAH patients.

Patient & Prescribing Data

Patients with aSAH at risk for delayed cerebral ischemia.

Cilostazol has a stronger evidence base compared to albumin.

Clinical Best Practices

• Utilize combination therapies in future research to address DCI prevention.
• Conduct randomized controlled trials to evaluate treatment effects.

Related Resources & Content

• AHA/ASA Guidelines
• CATS Protocol
• ALISAH Trial