Combination therapy of fasudil hydrochloride and ozagrel sodium for treating patients with aneurysmal subarachnoid hemorrhage: a cross-sectional study using a nationwide inpatient database

Abstract

Abstract No definitive conclusions have been drawn yet regarding the clinical efficacy of fasudil hydrochloride and ozagrel sodium monotherapy or their combination for subarachnoid hemorrhage (SAH). Therefore, we conducted this cross-sectional study using the Diagnosis Procedure Combination data to investigate the prognostic effects of the combined administration of fasudil hydrochloride and ozagrel sodium in Japanese patients with SAH. The participants were patients who were hospitalized with subarachnoid hemorrhage and received fasudil hydrochloride or ozagrel sodium between April 1, 2016, and March 31, 2020 (n = 17,346). The participants were divided into the fasudil hydrochloride monotherapy (F group, n = 10,484), ozagrel sodium monotherapy (O group, n = 465), and fasudil hydrochloride and ozagrel sodium combination therapy (FO group, n = 6,397) groups. The primary outcome was in-hospital mortality, and the secondary outcome was the proportion of patients with modified Rankin Scale (mRS) score ≤ 2 at discharge. Multivariable adjusted logistic regression analysis (significance level, 5%) was used for data analyses. With the F group as the reference, the adjusted odds ratio (OR) for in-hospital mortality was 0.99 for the FO group (95% CI: 0.86–1.14, p = 0.883) and 2.63 for the O group (95% CI: 1.95–3.56, p < 0.001). The OR for the proportion of patients with mRS score ≤ 2 at discharge was 0.93 for the FO group (95% CI: 0.86–1.00, p = 0.037) and 0.79 for the O group (95% CI: 0.64–0.98, p = 0.035). Our results indicate that prognosis tended to be better with their combined use compared to ozagrel sodium monotherapy.