Clinical Analysis of Risk Factors Affecting Rebleeding in Patients with an Aneurysm

Kim, Gab Teug

Abstract

BACKGROUND: The mortality of patients with rebleeding of an aneurysmal rupture is very high despite scheduling of an early operation. The period of greatest risk of rebleeding is during the time in which the patient is undergoing transport, assessment, diagnostic testing, and management in the emergency room or ward. If rebleeing can be prevented, it is clear that the overall clinical outcome for patients with an aneurysmal rupture will be dramatically improved. MATERIALS AND EMTHODS: To determine the risk factors for rebleeding in patients with an aneurysmal rupture between admission in emergency room and operation, we retrospectively reviewed the cases of 194 patients with an aneurysmal rupture that had been confirmed by CT scanning and cerebral angiography between January 1, 1998 and December 31, 2000. RESULT: Thirty-eight(19.6%) of the 194 patients had rebleeding. The incidence of rebleeding significantly increased in patients with stroke symptoms and signs on first-time aneurysmal ruptures(loss of consciousness, decreased mentality, coma, or motor deficits), in those with poor neurological conditions on admission, in those with a poor Hunt-Hess grade on admission(IV or V), and in those with a intracerebral hematoma indicated on the CT scanning compared to those without these factors. Multivariate analysis revealed that the following three factors were independently associated with rebleeding: the symptoms and signs on first-time aneurysmal ruptures, the Hunt-Hess grade on admission, and the value of prothrombin time on admission.
CONCLUSION
A considerably high risk of rebleeding was observed in those patients who had stroke symptoms and signs, who were in a poor Hunt-Hess grade(grade IV or V), and who had extremely delayed values of the prothrombin time.