AUTHOR=Wessell Aaron , Kole Matthew J. , Badjatia Neeraj , Parikh Gunjan , Albrecht Jennifer S. , Schreibman David L. , Simard J. Marc 

TITLE=High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Cotreated with Heparin Infusion

JOURNAL=Frontiers in Neurology

VOLUME=Volume 8 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00268

DOI=10.3389/fneur.2017.00268

ISSN=1664-2295

ABSTRACT=Introduction. We sought to determine whether compliance with scheduled nimodipine in subarachnoid hemorrhage patients impacted patient outcomes, with the intent of guiding future nimodipine management in patients who experience nimodipine-induced hypotension.
Methods. We performed a retrospective analysis of 118 consecutive aneurysmal subarachnoid hemorrhage patients treated with the Maryland Low-Dose IV Heparin Infusion Protocol. Patients were categorized into three independent nimodipine compliance groups: ≥ 1 dose held, ≥ 1 dose split, and no missed or split-doses. A split-dose was defined as 30 mg of nimodipine administered every 2 hours. Our primary outcome was discharge to home. Bivariate and multivariable logistic regression analyses were used to assess predictors of discharge disposition as a function of nimodipine compliance.
Results. Of the 118 patients, 20 (17%) received all nimodipine doses, 6 (5%) received split-doses but never had a full dose held, and 92 (78%) had ≥ 1 dose held. Forty five percent of patients were discharged to home, including 75% who received all doses, 67% who received 1 split-doses, and 37% with 1 missed doses (p=0.003). Multivariable analysis showed that, along with age and WFNS grade, nimodipine compliance was an independent predictor of clinical outcome; compared to missing one or more nimodipine doses, full dosing compliance was associated with increased odds of discharge to home (OR 5.20; 95% CI 1.46-18.56)). 
Conclusions. In aneurysmal subarachnoid hemorrhage patients with modified Fisher scores 2 through 4 who are co-treated with a low-dose heparin infusion, full compliance with nimodipine dosing was associated with increased odds of discharge to home.