BACKGROUND: Tirilazad is a non-glucocorticoid, 21-aminosteriod that inhibits 
lipid peroxidation. It had neuroprotective effects in experimental ischemic 
stroke and reduced angiographic vasospasm after experimental subarachnoid 
hemorrhage (SAH). Five randomized clinical trials of tirilazad were conducted in 
patients with SAH. We performed a meta-analysis of these trials to assess the 
effect of tirilazad on unfavorable outcome, symptomatic vasospasm, and cerebral 
infarction after SAH.
METHODS: Data from 3,797 patients were analyzed and modeled using random effect 
and Mantel-Haenszel meta-analyses and multivariable logistic regression to 
determine the effect of tirilazad on clinical outcome, symptomatic vasospasm, 
and cerebral infarction. Clinical outcome was assessed 3 months after SAH using 
the Glasgow outcome scale, and symptomatic vasospasm was defined by clinical 
criteria with laboratory and radiological exclusion of other causes of 
neurological deterioration.
RESULTS: The five trials were randomized, double-blind, and placebo-controlled. 
Tirilazad did not significantly decrease unfavorable clinical outcome on the GOS 
(odds ratio [OR] 1.04, 95% confidence interval [CI] 0.89-1.20) or cerebral 
infarction (OR 1.04, 95% CI 0.89-1.22). There was a significant reduction in 
symptomatic vasospasm in patients treated with tirilazad (OR 0.80, 95% CI 
0.69-0.93). There was no heterogeneity across the five trials.
CONCLUSION: Tirilazad had no effect on clinical outcome but did decrease 
symptomatic vasospasm in five trials of aneurysmal SAH. The dissociation between 
clinical outcome and symptomatic vasospasm deserves further investigation.