Publication year: 2012
Source:World Neurosurgery
Carl Christian Larsen, Jens Astrup
Objective Rebleeding is a major contributor to morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). However, little is known to what causes rebleeding. During the last decades several risk factors have been identified to be associated with rebleeding although several discrepancies exist. The aim of this review is to summarize the current knowledge of the mechanisms leading to rebleeding and the prevention hereof after SAH. Methods A literature search was performed to investigate factors associated with rebleeding after SAH. Results The review of the literature revealed that rebleeding is a complex and multifactorial event involving haemostasis, pathophysiological and anatomical factors. Administration of antifibrinolytics has been shown to have a dramatic effect on the rebleeding rate so changes in coagulation and fibrinolysis must be involved in rebleeding. Conclusion Further studies are warranted before the exact mechanisms leading to rebleeding is established and the optimal preventive measures are made available. Currently antifibrinolytic therapy remains the only realistic protective measure during the initial 6 hours after SAH during which the rebleeding rate is highest.
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