Tirilazad for aneurysmal subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) is a life-threatening type of stroke caused when a small blood vessel near the surface of the brain bursts. The bleeding usually comes from an aneurysm (a weakness in the blood vessel wall). The blood enters the fluid-filled space around the brain called the subarachnoid space, which lies between the outer surface of the brain and the inner surface of the skull. Thus, the condition is called aneurysmal SAH. Approximately one-third of patients develop a complication of the bleeding in which narrowing of the blood vessels occurs. In turn, this may cause the blood supply to parts of the brain to be reduced or stopped. The resulting brain damage is called delayed cerebral ischaemia. It happens most often four to 10 days after SAH, and it can cause disability or even death. In animal studies, the drug tirilazad appeared to reduce brain damage after SAH. We reviewed the evidence from randomised controlled trials of tirilazad in patients with SAH to see if it could reduce the risk of death or disability. The review did not show any evidence of benefit from tirilazad in patients with aneurysmal SAH.