Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage

Publication Date: July 20, 2011
Last Updated: March 14, 2022

Recommendations

Early aneurysm repair should be undertaken, when possible and reasonable, to prevent rebleeding. (High, Strong)
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An early, short course of antifibrinolytic therapy prior to early aneurysm repair (begun at diagnosis; continued up to the point at which the aneurysm is secured or at 72 h post-ictus, whichever is shorter) should be considered. (Low, Weak)
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Delayed (>48 h after the ictus) or prolonged (>3 days) antifibrinolytic therapy exposes patients to side effects of therapy when the risk of rebleeding is sharply reduced and should be avoided. (High, Strong)
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Antifibrinolytic therapy is relatively contraindicated in patients with risk factors for thromboembolic complications. (Moderate, Strong)
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Patients treated with antifibrinolytic therapy should have close screening for deep venous thrombosis. (Moderate, Strong)
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Antifibrinolytic therapy should be discontinued 2 h before planned endovascular ablation of an aneurysm. (Very Low, Weak)
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When CTA and DSA are both available and CTA is of high technical quality, CTA should be performed preferentially if endovascular intervention is not planned at the time of angiography. (Very Low, Weak)
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Treat extreme hypertension in patients with an unsecured, recently ruptured aneurysm. Modest elevations in blood pressure (mean blood pressure <110 mmHg) do not require therapy. Pre-morbid baseline blood pressures should be used to refine targets; hypotension should be avoided. (Low, Strong)
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Recommendation Grading

Overview

Title

Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage

Authoring Organization

Neurocritical Care Society

Publication Month/Year

July 20, 2011

Last Updated Month/Year

August 21, 2023

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Outpatient

Intended Users

Speech language pathologist, physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Rehabilitation, Management, Treatment

Diseases/Conditions (MeSH)

D013345 - Subarachnoid Hemorrhage

Keywords

Aneurysmal Subarachnoid Hemorrhage, subarachnoid hemorrhage (SAH), aneurysm