Spontaneous Subarachnoid Hemorrhage: Assessment of Prognosis and Initial Management in the Intensive Care Unit

Thie, Andreas; Spitzer, Klaus; Kunze, Klaus

doi:10.1177/088506668700200206

Cited by 2 publications

(2 citation statements)

References 126 publications

(117 reference statements)

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“…There does not appear to be an excess risk of hydrocephalus or cerebral infarction asso ciate d w ith F XIII the ra py. Th e rate of hyd roeephalus (7 %) in this pilot st udy was in the lower range of the reported incidence of hyd roee pha lus in the lite ra ture (7). It is similar 10 the hydroeepha lus rat e in the no-an üfibrinolytic-gr oup of Kassel!…”

Section: Cuus Es Ofdeu Thmentioning

confidence: 40%

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Factor XIII concentrate for prevention of recurrent subarachnoid hemorrhage: results of a multicenter pilot study

Thie

Henze²

1991

Minim Invasive Neurosurg

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Rebleeding after aneurysmal subarachnoid hemorrhage (SAH) has been attributed to fibrinolysis of the blood clot surrounding a rupture aneurysm. Since stability of the clot is influenced by the action of coagulation factor XIII (F XIII), high levels of F XIII might be beneficial in preventing recurrent SAH without causing the severe side effects of synthetic antifibrinolytics. We performed an open multicenter pilot study with administration of 10 x 1250 units of F XIII concentrate during the first 15 days after spontaneous SAH. Of 111 patients who were entered within 72 hours after SAH, 48 (43%) were in grades I and II, 33 (30%) were in grade III, and 30 (27%) were in grades IV and V according to Hunt & Hess. Aneurysm rupture was proved in 76 patients (68%) and aneurysm surgery was performed in 50 patients (45%). Overall mortality at four weeks was 27%. There were 11 recurrent hemorrhages in 9 patients (10%), 7 of which were fatal. Cerebral infarction occurred in 22 patients (20%) and hydrocephalus in 8 (7%). No adverse effects of therapy were noted. We conclude that F XIII therapy is a safe and promising new therapeutic approach in the management of SAH. It is currently being investigated in a large prospective, randomized, double-blind, placebo-controlled trial.

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Section: Cuus Es Ofdeu Thmentioning

confidence: 40%

“…Reble eding oeeurs in 12-30 % of patients with a ne urys mal subarachnoid hem orrhage (SAH) (7), and is a major cause of mortality and rnorbidity. Recurrent hem orrhage ha s been att ribut ed to fibrinolysis of th e blood clot surrounding a ruptured aneurysm .…”

Section: Tre Atm Entmentioning

confidence: 99%

Factor XIII concentrate for prevention of recurrent subarachnoid hemorrhage: results of a multicenter pilot study

Thie

Henze²

1991

Minim Invasive Neurosurg

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Spontaneous subarachnoid haemorrhage: expert system for appraisal of the prognosis and computer-supported decision for therapy

1988

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An expert system is presented which allows appraisal of the prognosis and a computer-supported decision for the therapy of patients with acute spontaneous subarachnoid haemorrhage (SAH). The knowledge of physicians as a synthesis of their own and other clinicians' experience is simulated with methods of artificial intelligence by setting up two data banks. In one data bank, selected information on the correlation between initial clinical parameters, on the one hand, and mortality, outcome and complications, on the other, from about 250 neurological publications is stored, taking into consideration the therapeutic regimens applied. A second data bank receives clinical and laboratory data profiles of a patient population which has already been treated. The expert system is able to compare the individual initial findings with the corresponding parameter combination stored in the data banks regarding the decision for therapy of a patient to be treated. This enables both calculation of the probable complications and prediction of the expected outcome in relation to various possible forms of therapy. The expert system can thus indicate the kind of therapy where the lowest number of complications and the best outcome can be expected, thus supporting the decision of the physician. As each new patient is treated, the volume of stored information increases, so the system possesses self-learning characteristics. To check the validity of the prognoses, the outcome estimated by the expert system for 51 patients with spontaneous SAH was compared with the actual outcome, and a high level of agreement was attained.

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Spontaneous Subarachnoid Hemorrhage: Assessment of Prognosis and Initial Management in the Intensive Care Unit

Cited by 2 publications

References 126 publications

Factor XIII concentrate for prevention of recurrent subarachnoid hemorrhage: results of a multicenter pilot study

Factor XIII concentrate for prevention of recurrent subarachnoid hemorrhage: results of a multicenter pilot study

Spontaneous subarachnoid haemorrhage: expert system for appraisal of the prognosis and computer-supported decision for therapy

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