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INNOSC Theranostics and
Pharmacological Sciences Novel pharmacologic therapies for SAH

Table 1. All available treatment options for subarachnoid hemorrhage
Treatment types Pharmacologic treatment Surgical treatment Novel therapies
Treatments Blood pressure control Craniopuncture Exosomes
Tranexamic acid Craniotomy NDP-MSH
Factor VIII Hematoma aspiration and thrombolysis Proteosomes-HMGB1, and purpurogallin
Antioxidants Neuroendoscopy and evacuation Liproxstatin-1
Glycyrrhizic acid
Clazosentan and endothelin receptor antagonists
Abbreviations: HMGB1: high mobility group box 1; NDP-MSH: Nle4DPhe7-α-melanocyte-stimulating hormone.

4.6. Clazosentan and endothelin receptor Table 2. Clinical trials on subarachnoid hemorrhage (SAH)
antagonists
Clinical trials Details of the clinical trials
Clazosentan, an endothelin receptor antagonist, has CONSCIOUS-1 The CONSCIOUS-1 trial aimed to investigate the
demonstrated promise in preventing cerebral vasospasm Trial potential of clazosentan, an endothelin receptor
and improving outcomes post-SAH. Clinical trials, such as antagonist, in preventing neurological ischemia
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CONSCIOUS-1 and CONSCIOUS-2, have substantiated and infarction following SAH . This randomized,
their efficacy in reducing the incidence of vasospasm- double-blind, placebo-controlled phase 2 trial
assessed the drug’s effectiveness and safety in
related morbidity 79,80 . improving outcomes for SAH patients.
4.7. Calcium antagonists for SAH CONSCIOUS-2 Building upon the findings of CONSCIOUS-1, the
Trial CONSCIOUS-2 trial expanded the investigation into
A Cochrane systematic review explored the use of calcium clazosentan’s efficacy in SAH patients undergoing
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antagonists in the management of aneurysmal SAH, with surgical clipping . This phase 3 trial continued
the aim of determining their effectiveness and safety . The to explore its potential in preventing adverse
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neurological outcomes post-SAH.
insights derived from these clinical trials and systematic
reviews have contributed significantly to advancing our STASH Trial The STASH trial investigated the use of simvastatin, a
statin medication, in patients with aneurysmal SAH .
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knowledge of treatment strategies for SAH, which helps This multicenter, randomized phase 3 trial aimed to
to improve patient outcomes and reduce complications determine whether simvastatin could improve patient
associated with this condition. outcomes and reduce complications following SAH.
4.8. Triple-H therapy optimization Recent systematic reviews highlight its importance in
Triple-H therapy has long been used to prevent vasospasm. guiding treatment decisions and improving patient
Recent research, however, emphasizes the importance of outcomes . ICP monitoring is critical in SAH management,
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individualizing its components to achieve optimal cerebral allowing continuous assessment of intracranial dynamics.
perfusion while mitigating potential complications . Numerous scholarly articles explore relevant topics 81,82,88,89 ,
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Triple-H therapy involves the manipulation of hemodynamic covering topics including:
parameters, namely hypertension, hypervolemia, and (i) The importance of ICP monitoring in identifying and
hemodilution. The principles, controversies, and outcomes managing elevated ICP.
associated with triple-H therapy can be explored in (ii) Various monitoring techniques, including
scholarly articles 80,81,83-86 , which cover topics including: intraventricular and intraparenchymal monitors.
(i) The rationale behind inducing hypertension to (iii) The correlation between elevated ICP and poor
improve cerebral perfusion. outcomes in SAH patients.
(ii) The role of hypervolemia in preventing DCI. (iv) Controversies surrounding the threshold for
(iii) The use of hemodilution to reduce blood viscosity and intervention based on ICP values.
enhance microcirculation.
(iv) Challenges in achieving the delicate balance of these 4.10. Statin therapy
parameters. Statins, particularly simvastatin, have exhibited potential
in reducing the incidence of vasospasm and improving
4.9. Intracranial pressure monitoring clinical outcomes post-SAH. The STASH trial demonstrated
Intracranial pressure monitoring plays a crucial role in the safety and efficacy of statins in this context . Table 1
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identifying and managing secondary insults post-SAH. provides a summary of all available treatment options.

Volume 7 Issue 2 (2024) 10 doi: 10.36922/itps.2019