An Analysis of Factors Related to Rebleeding in Patients with Aneurysmal Subarachnoid Hemorrhage

Lee, Chang Young; Yim, Man Bin; Suh, In Yeup; Kim, Ill Man; Son, Eun Ik; Kim, Dong Won

Abstract

OBJECTS: To assess risk factors related to the occurrence of rebleeding in patients with aneurysmal subarachnoid hemorrhage (SAH) who had been planned to the early surgery, this study was conducted retrospectively. MATERIAL AND METHODS: During the period from January, 1993 to December, 1995, 258 patients with aneurysmal SAH who admitted within 3 days of their SAH and had been planned to early surgery were selected as study population. Ten variables including age, sex, hypertension history, rebleeding before admission, systolic blood pressure on admission, intracerebral or intraventricular hematoma, clinical grade, computed tomographic (CT) grade, admission time after SAH, hemostatic parameter were analyzed by the univariate and multivariate logistic regression method using the Statistical Analysis System (SAS).
RESULTS
Of the 258 patients, 25 (9.69%) patients had rebleeding. Admission within 2 hours after SAH (p=0.001), clinical grade IV-V (p=0.015), rebleeding before admission (p=0.000), and intracerebral or intraventricular hematoma (p=0.04) appeared to be associated with a higher risk of rebleeding on the univariate analysis. Particularly, the patients who admitted to hospital within 2 hours after SAH and who are clinical grade IV or V appeared to be more likely to have early rebleeding. Rebleeding before admission was revealed as a independent factor associated with rebleeding on the multivariate logistic regression analysis.
CONCLUSION
The short course use of antifibrinolytics, 3-dimensional CT angiography and endovascular surgery should be considered for the patients with aneurysmal SAH who have rebleeding history before admission, intracerebral or intraventricular hematoma, who admit to hospital within 2 hours after SAH, and who are clinical IV or V to minimize rebleeding in the interval between SAH attack and early surgery.