Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage

Baharoglu, Merih I; Germans, Menno R.; Rinkel, Gabriël J.E.; Algra, Ale; Vermeulen, M.; Gijn, J. van; Roos, Yvo B.W.E.M.

doi:10.1002/14651858.cd001245.pub2

Cited by 133 publications

(102 citation statements)

References 56 publications

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“…It is therefore still unknown whether the application of antifibrinolytic therapy is really useful. 23 Currently, a prospective trial investigates whether ultraearly tranexamic acid administration prevents rebleeding and subsequently also leads to a better outcome. 24 It is clear that emergency aneurysm repair avoids the possible use of antifibrinolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Donkelaar

Bakker

Veeger

et al. 2015

Stroke

115

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for example, acute hydrocephalus requiring external cerebrospinal fluid (CSF) drainage, can also interfere with early treatment. Traditionally, the critical time frame for ruptured Background and Purpose-Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We therefore aimed to determine predictors for an early rebleeding after aSAH in relation with time after ictus. Methods-This observational prospective cohort study included all consecutive patients admitted with aSAH between January 1998 and December 2014 (n=1337) at our University Neurovascular Center. Clinical predictors for rebleeding ≤24 hours were identified using multivariable Cox regression analyses. Kaplan-Meier analyses were applied to evaluate the time of rebleeding ≤72 hours after aSAH. Results-A modified Fisher grade of 3 to 4 was a predictor for an in-hospital rebleeding ≤24 hours after ictus (adjusted hazard ratio, 4.4; 95% confidence interval, 2.1-10.6; P<0.001). The numbers needed to treat to prevent 1 rebleeding ≤24 hours was calculated 15 (95% confidence interval, 10-25). Also, the initiation of external cerebrospinal fluiddrainage (adjusted hazard ratio, 1.9; 95% confidence interval, 1.4-2.5; P<0.001) was independently associated with a rebleeding ≤24 hours. Cumulative in-hospital rebleeding rates were 5.8% ≤24 hours, and 1.2% in the time frame 24-72 hours after ictus. Conclusions-In our opinion, timing of treatment of aSAH patients, especially those with an modified Fisher grade of 3 or 4 in a good clinical condition, should be reconsidered. These aSAH patients might be regarded a medical emergency, requiring aneurysm repair as soon as possible. In this respect, our findings should provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding. (Stroke. 2015;46:2100-2106.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Donkelaar

Bakker

Veeger

et al. 2015

Stroke

115

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“…16 17 For example, raised intracranial pressure can lead to cerebral hypoperfusion. [18][19][20] Thrombotic disseminated intravascular coagulation might increase the risk of cerebral microthrombi, which are often seen in the brains of patients with traumatic brain injury who have died. 21…”

mentioning

confidence: 99%

Does tranexamic acid improve outcomes in traumatic brain injury?

Mahmood

Roberts

Shakur

et al. 2016

BMJ

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“…Длительное применение антифи-бринолитиков с целью уменьшить риск повторного кровотечения может еще больше снижать эффек-тивность консервативного лечения церебральной ишемии [8].…”

Section: Discussionunclassified

The use of transcallosal ventriculostomy to treat complicated forms of aneurismal intracranial hemorrhages

2015

Vopr. neirokhir.

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Ранние микрохирургические вмешательства в остром периоде аневризматического внутричереп-ного кровоизлияния (АВК) традиционно относят к операциям повышенного хирургического риска.Техническая сложность таких операций много-кратно возрастает при наличии у пациента ослож-ненных форм АВК: гемотампонады базальных ци-стерн, массивного внутримозгового и/или внутри-желудочкового кровоизлияния [4]. У данного кон-тингента больных оперирующий хирург нередко сталкивается с ситуацией, когда проведенные ане-стезиологом мероприятия по созданию «мягкого мозга» [15] оказываются недостаточными и напря-жение вещества мозга остается значительным. В этих случаях для успешного проведения основного этапа операции необходимо добиться релаксации вещества мозга хирургическими методами [6].В основе релаксации мозга лежит возможность посредством оперативных приемов осуществить «внутреннюю декомпрессию мозга» путем аспира-ции ликвора и кровяных сгустков из «резервных внутричерепных пространств» [2].Одним из наиболее эффективных, но техниче-ски сложных способов релаксации мозга является

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Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage

Cited by 133 publications

References 56 publications

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage

Does tranexamic acid improve outcomes in traumatic brain injury?

The use of transcallosal ventriculostomy to treat complicated forms of aneurismal intracranial hemorrhages

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