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Rebleeding
Rebleeding will be fatal immediately in approximately one-third of good-grade patients and half of poor-grade patients. Several factors are associated with higher risk of rebleeding, these include poor neurologic grade, advanced age, moderate to severe hypertension, and female gender.1
Surgical clipping of the aneurysm. Current guidelines recommend early surgery (0-3 days) for good-grade patients with an uncomplicated aneurysm, but either early or delayed surgery is recommended for patients with other clinical situations, such as aneurysm complexity or surgical difficulty.2 Early surgery has several advantages: elimination of rebleeding risk; removal of subarachnoid blood, which reduces risk of vasospasm; and potential reduction in length of hospitalization.2 However, exposure of the aneurysm during early surgery may be made more difficult by brain swelling and the presence of clots in the subarachnoid cisterns.
Antifibrinolytic drugs. Guidelines recommend antifibrinolytic drugs only in certain clinical situations-patients who have a low risk of vasospasm or those who would benefit from delayed surgery.2 Antifibrinolytics do not improve overall outcome; they appear to reduce the risk of rebleeding at the cost of increasing risk of cerebral ischemia.4
Other techniques. Antihypertensive drugs and bed rest should not be used alone as a means to prevent rebleeding; rather, bed rest and antihypertensive drugs may be included in the overall treatment strategy.2 Carotid ligation may reduce rebleeding, however, it likely produces a higher rate of treatment failures than direct surgical clipping of the aneurysm. Guidelines indicate that carotid ligation has indeterminate value in preventing rebleeding.2 The use of intraluminal coils or detachable balloons to occlude the aneurysm remains experimental. Although short-term studies suggest that these techniques lead to aneurysmal thrombosis, long-term studies in defined patient populations are still needed.2
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 | To learn more about therapeutic measures for cerebral vasospasm, click here |
Sources:
- Weir B. Protection of the brain after aneurysmal rupture. Can J Neurol Sci 1995;22:177-186.
- Mayberg MR, Batjer HH, Dacey R et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994;25:2315-2328.
- Findlay JM. Current management of aneurysmal subarachnoid hemorrhage guidelines from the Canadian Neurosurgical Society. Can J Neurol Sci 1997;24:161-170.
- Kassell NF, Torner JC, Adams HP Jr. Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage: preliminary observations from the Cooperative Aneurysm Study. J Neurosurg 1984;61:225-230.
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DO NOT ADMINISTER NIMOTOP INTRAVENOUSLY OR BY OTHER PARENTERAL ROUTES. DEATHS AND SERIOUS, LIFE-THREATENING ADVERSE EVENTS HAVE OCCURRED WHEN THE CONTENTS OF NIMOTOP CAPSULES HAVE BEEN INJECTED PARENTERALLY
(See
WARNINGS and DOSAGE AND ADMINISTRATION.) |
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- In patients with SAH, Nimotop® controls damage with a low side effect profile.
- Decreased blood pressure is the most common side effect, occurring in 4.4% of patients. Blood pressure should be monitored during therapy.1
- Other side effects occurring at a low frequency of ≥1.0% include headache, nausea, and bradycardia.1
- No clinically significant effects on hematologic factors, renal or hepatic function, or carbohydrate metabolism have been causally associated with oral nimodipine.1
- Nimotop® does not appear to affect anesthetic management.2
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Sources:
- Nimotop® (nimodipine) Capsules Prescribing
Information December 2005
- Stullken EH, Johnston WE, Prough DS. Implications of nimodipine prophylaxis of cerebral vasospasm on anesthetic management during intracranial aneurysm clipping. J. Neurosurg. 1985; 62:200-205.
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© Bayer HealthCare Pharmaceuticals.
Bayer HealthCare Pharmaceuticals
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Wayne, NJ 07470
The information provided on Bayer products is only intended for the United States audience. Regulatory requirements, regulations, laws, and distribution of information about drug products may vary from country to country. Product names and indications (product uses) also may be different in different countries. The prescribing information provided here is based on United States labeling and may not be appropriate outside of the US.
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