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Use of Mannitol Questioned in Acute Stroke Treatment: Presented at ESC

By Adrian Burton

VALENCIA, SPAIN -- May 22, 2003 -- Routine use of mannitol may not help, and could even be harmful, in patients having an acute stroke, a Hungarian study suggests.

"Mannitol is used because it's thought to decrease brain oedema, because it is a free radical scavenger, and because it might improve the fluidity of the blood," said Daniel Bereczki, Professor of Neurology at University of Debrecen, in Debrecen, Hungary, while presenting a study here May 22^nd at the 2003 European Stroke Conference. "But there is no real evidence to support this [theory]."

Dr. Bereczki's team tried to test whether mannitol was indeed have post-stroke benefits by examining 804 patients who presented to hospital less than 72 hours following a stroke. Those presenting with transient ischaemic attacks or subarachnoid haemorrhage were excluded from the evaluation.

On admission to hospital, patients were assessed for level of consciousness (LOC), blood sugar level, white blood cell count and fever. All patients also were assessed on items of the Scandinavian Neurological Stroke Scale (SNSS) and their 30-day and 1-year survivals were recorded.

Of the 804 patients examined, 523 received mannitol between 25 to 69 g/day for 3 to 9 days.

Results showed that 26% of patients who received mannitol died within 30 days, while 16% of those who had not been given this treatment died in that time period (P<0.006). At 1 year, 38% and 25% had died, respectively (P<0.01).

The SNSS prognostic score for the mannitol-treated patients was significantly different from that of patients who had not received the drug (mean 15.3 compared to 16.6, respectively; P=0.001). Long-term scores on SNSS showed a similar difference (25.0 compared to 29.5; P<0.001).

Logistic regression showed older age (P=0.02), disturbed LOC (P<0.001), high white cell count (P<0.001) and mannitol treatment to be significantly linked to increased risk of death at 30 days and 1 year (P<0.005). Mannitol became non-significant, however, if LOC was substituted for SNSS in the analysis (P=0.11).

"These figures are not proof but they do raise concern," concluded Dr. Bereczki. "There is not even a suggestion that mannitol is efficient -- it is either harmful or has no effect on survival. The American Heart Association recommends mannitol for selected patient groups. I think even that should be reconsidered."


[Study title: Mannitol Use in Acute Stroke and Case Fatality at 30 Days: An Observational Study. Abstract P164]

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