Impact of Medical Treatment on the Outcome of Patients After Aneurysmal Subarachnoid Hemorrhage

Vermeij, Frédérique H; Hasan, D.; Bijvoet, Henk W. C.; Avezaat, C. J. J.

doi:10.1161/01.str.29.5.924

Cited by 73 publications

(48 citation statements)

References 53 publications

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“…here have been many reports investigating aneurysmal rebleeding, because it is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH) [1][2][3] in addition to the primary bleeding and delayed ischemic deterioration. 4 The cumulative incidence of aneurysmal rebleeding within the first 2 weeks has been estimated to be from 9% to 23%, 3,[5][6][7][8] and the mortality due to rebleeding has been reported to range between 50% and 80%.…”

mentioning

confidence: 99%

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Ohkuma

Tsurutani

Suzuki

2001

Stroke

301

182

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Background and Purpose-Rebleeding is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH); however, there has been no report focusing on rebleeding before hospitalization in neurosurgical or neurological institutions. The aim of this study was to clarify the incidence of prehospitalization rebleeding, its impact on the clinical course and prognosis in patients with aneurysmal SAH, and the possible factors inducing it. Methods-In 273 patients who were admitted to our institution within 24 hours after the initial SAH bleeding and whose clinical course before admission could be fully evaluated, the patients' clinical conditions and CT findings on admission, operability, prognosis, and possible factors inducing rebleeding were comparatively evaluated between the patients with and without an episode of prehospitalization rebleeding. Results-Of the 273 patients, 37 (13.6%) patients suffered from 39 episodes of rebleeding in the ambulance or at the referring hospital before admission to our hospital. The peak time of rebleeding was within 2 hours (77%), in which the incidence was statistically significant compared with that occurring 2 to 8 hours after the initial SAH bleeding (PϽ0.01).The group experiencing rebleeding showed more severe Hunt and Hess grades on admission, higher rates of intracerebral hematoma, of intraventricular hematoma, and of subdural hematoma on CT scan on admission, less operability, and poorer prognoses with statistically significant differences compared with the group that did not experience rebleeding. Systolic arterial pressure Ͼ160 mm Hg was a possible risk factor of rebleeding (odds ratio 3.1, 95% CI 1.5 to 6.8). Conclusions-Rebleeding during transfer and at the referring hospital is not rare. To improve overall outcome of aneurysmal SAH, the results obtained in this study should be made available to general practitioners and the doctors devoted to emergency medicine.

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confidence: 99%

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Ohkuma

Tsurutani

Suzuki

2001

Stroke

301

182

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“…A number of studies using both antifibrinolytics and either nicardipine or nimodipine reported decreased rebleeding, no increase in ischemic deficits, and improved outcomes [15,26,28,41,42]. Rebleeding rates ranged from 7% to 13% and mortality ranged from 11% to 12%.…”

Section: Other Non-randomized Clinical Trialsmentioning

confidence: 99%

Antifibrinolytic Therapy To Prevent Early Rebleeding After Subarachnoid Hemorrhage

et al. 2008

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In the current era of early surgery, there has been little interest in the use of antifibrinolytic therapy to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). Older studies demonstrated that antifibrinolytics can reduce rebleeding, but long-term therapy results in increased cerebral ischemia from vasospasm, leading to no appreciable effect on mortality. While early surgery would seem to obviate the need for long-term antifibrinolytic use, a subgroup of patients may benefit from early therapy. The rate of pre-operative rebleeding may be as high as 9-17%, causing significant morbidity and mortality. Short-term use of antifibrinolytic agents (less than 3 days) in the presence of calcium channel blocking therapy has shown promising results. A randomized clinical trial of early antifibrinolytic therapy conducted in 2002 showed a significant decrease in rebleeding and a non-significant decrease in overall mortality. In this review, we examine the clinical pharmacology, dosing, monitoring, complications, and side effects of antifibrinolytic treatment. We conclude that early short-term antifibrinolytic therapy might be a reasonable strategy to prevent acute rebleeding and improve long-term outcome in aSAH patients. Additional randomized clinical trials are necessary to determine whether this management strategy is effective.

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“…An understanding of this situation has resulted in a move away from fluid restriction in SAH patients to administering sodium containing solutions so that circulating volume is maintained at normal or supra-normal levels. A number of non-randomised trials in which patients were given at least 3 litres per day of saline 0.9% have indicated a decreased rate of delayed cerebral ischaemia and a better overall outcome [63,64]. A recent Cochrane review concluded that there is no sound evidence for or against the use of volume expansion therapy in those patients with aneurysmal subarachnoid haemorrhage [65].…”

Section: Measures Aimed At Decreasing the Risk Of Rebleedingmentioning

confidence: 99%

Management of subarachnoid haemorrhage in a non‐neurosurgical centre

Wilson¹,

Hirsch²,

Appleby³

2005

Anaesthesia

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SummarySubarachnoid haemorrhage is a common neurological emergency, which carries a high morbidity and mortality. It is usually caused by rupture of an intracerebral aneurysm or, less commonly, an arteriovenous malformation. Although most patients present to a non‐neurosurgical hospital, they often require urgent neurosurgical or neuroradiological intervention. Whilst awaiting transfer to a neurological centre, active management of the patient must be instituted. This should include confirmation of the diagnosis with CT imaging, lumbar puncture or both, and recognition of the complications of subarachnoid haemorrhage, which include hydrocephalus, further haemorrhage and cerebral vasospasm. Medical management is directed towards maintaining adequate cerebral perfusion pressure whilst avoiding large increases in arterial blood pressure. Nimodipine therapy must be started early in an attempt to prevent cerebral vasospasm. The treatment options available at the neurological centre include surgical treatment or endovascular obliteration of the aneurysm or arteriovenous malformation.

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Impact of Medical Treatment on the Outcome of Patients After Aneurysmal Subarachnoid Hemorrhage

Cited by 73 publications

References 53 publications

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Antifibrinolytic Therapy To Prevent Early Rebleeding After Subarachnoid Hemorrhage

Management of subarachnoid haemorrhage in a non‐neurosurgical centre

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