Magnesium exerts hemostatic effects in intracerebral haemorrhage by reduced hematoma expansion: FAST-MAG analysis

Observational studies have shown that magnesium may possess hemostatic effects. FAST-MAG was a pragmatic clinical trial of magnesium sulfate administered prehospital for acute clinical stroke syndromes. It included patients with intracerebral haemorrhage.

Exploratory secondary analysis by the treatment group revealed no reduction in hematoma expansion (HE) linked with magnesium treatment in intracerebral haemorrhage but did not consider serum Mg levels achieved. Eric M. Liotta, Northwestern University, Chicago, IL, and colleagues analyzed FAST-MAG data on intracerebral haemorrhage for associations between serum magnesium level, hematoma expansion, and early neurological deterioration, accounting for groupwise biases.

Hematoma expansion was defined as ≥3 mL increase in the hematoma volume within 24 hours and early neurological deterioration as decline of ≥1-point Glasgow Coma Scale from arrival to hospital ay 4. The biased availability of neuroimaging data was confirmed by comparing treatment and placebo groups. Therefore, HE and neurological deterioration were analyzed and stratified by treatment and placebo groups using adjusted logistic regression and univariate tests.

The researchers reported the following findings:

· Spontaneous intracerebral haemorrhage was present in 381 patients.

· Placebo patients had fewer serial neuroimaging studies available (65.4% versus 75.1%).

· Necessary data were available in 104 magnesium- and 85 placebo-treated patients (age, 64.9 years; 67.7% male).

· In the magnesium group, higher magnesium level was associated with less HE (adjusted odds ratio, 0.64 per mg/dL) and less neurological deterioration (adjusted odds ratio, 0.54 per mg/dL).

· In the placebo group, magnesium level was not associated with either HE or neurological deterioration.

"Magnesium may exhibit a hemostatic effect that was only observable in the FAST-MAG magnesium treatment group," the researchers wrote. "Equipoise should be maintained, and there is a need for specific trials."

Reference:

Liotta EM, Maas MB, Prabhakaran S, Shkirkova K, Sanossian N, Liebeskind DS, Sharma L, Stratton S, Conwit R, Saver JL; FAST-MAG Investigators and Coordinators. Magnesium and Hematoma Expansion in Intracerebral Hemorrhage: A FAST-MAG Randomized Trial Analysis. Stroke. 2023 Dec 21. doi: 10.1161/STROKEAHA.123.043555. Epub ahead of print. PMID: 38126183.