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Few conditions evince potential for disaster or cure as vividly as subarachnoid hemorrhage. If the patient survives the initial bleeding intact or with minor deficits, clipping of the aneurysm virtually eliminates the risk of recurrence. However, before something definite can be done, the patient faces the risk of rebleeding and later that of vasospasm. As Dr Adams documents, 20% of patients with subarachnoid hemorrhage will rebleed, half of them in the first 24 hours. Two thirds of those who rebleed die. The obvious solution is to operate before rebleeding or vasospasm can occur, a logical but unpopular approach because of the high perioperative complication rate of early intervention.
Both Adams and Weir agree that the published evidence shows that in patients treated with antifibrinolytics, the advantages of decreased rebleeding rates are negated by the increase in ischemic complications and hydrocephalus. Dr Adams states that if the usual therapeutic lag
Hachinski V. Antifibrinolytics in Subarachnoid Hemorrhage. Arch Neurol. 1987;44(1):118. doi:10.1001/archneur.1987.00520130092026
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