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      Management of Subarachnoid Haemorrhage: A Decision Analysis

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          Abstract

          The management of subarachnoid haemorrhage is studied by decision analysis. Optimal treatment strategies for individual patients are identified, by combining early surgery (on day 2), delayed surgery (on day 10), late elective surgery after 3 months, antifibrinolytics and nimodipine. The risks of rebleeding, infarction and mortality from the initial haemorrhage were estimated by proportional hazards regression in a reanalysis of a randomized clinical trial of antifibrinolytics against placebo. These combined with data from the literature are used in a decision tree to compute the chances of good recovery, moderate and severe disability and death after 3 months, and the (discounted quality-adjusted) life expectancy for each treatment strategy. Treatment with nimodipine is recommended for all patients. For patients in good clinical condition at admission, antifibrinolytics and delayed surgery form the optimal treatment strategy. However, the benefits of early or delayed surgery are small compared to elective late surgery in this group, and therefore the surgical complication rate should be low. Patients with a heavy load of subarachnoid blood on CT scan should be treated with (delayed) surgery, but not with antifibrinolytics, because of the increased risk of infarction. Late elective surgery is recommended for patients with good outcome after 3 months who have not yet been operated.

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          Author and article information

          Journal
          CED
          Cerebrovasc Dis
          10.1159/issn.1015-9770
          Cerebrovascular Diseases
          S. Karger AG
          1015-9770
          1421-9786
          1995
          1995
          28 August 1995
          : 5
          : 5
          : 350-357
          Affiliations
          a Center for Clinical Decision Sciences, Department of Public Health, Erasmus University, and b Department of Neurology, Dijkzigt Hospital, Rotterdam, c Department of Neurology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands; d Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
          Article
          107881 Cerebrovasc Dis 1995;5:350–357
          10.1159/000107881
          © 1995 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 8
          Categories
          Original Paper

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