PROGNOSIS OF SUBARACHNOID HEMORRHAGE DURI NG A COMBINED THERAPY WITH ANTIFIBRINOLYTICS AND CALCIUM-ANTAGONISTS

The effectiveness of antifibrinolytic therapy after SAB as prophylaxis mean to prevent rebleeding is undispured; however its application res ults in an increased vasospasm rate. For this reasons after introducti on of the calcium antagonist therapy antifibrinolytic therapy is consi dered with caution. Within a retrospectiv study patients of the last 3 years suffering a subarachnoid hemorrhage (n = 56) and undergoing tre atment in our neurologic intensive care unit were investigated. In 57% rupture of an aneurysm was causative, in 25% spontaneous hemorrhage o f unknown or:gin had to be postulated. Patients with other causes such as trauma (12.5%), anticoagulation therapy (3.6%) and tumor (1.8%) we re excluded. Of the patients, which were not appropriate for early ope ration (65.3%), 77% were treated with a combination of tranexamacid (6 g/24 h i.v.) and nimodipin (2 mg/h i.v.). In this group 4.3% suffered rebleeding, in 13% vasospasm. 3 patients with an initial score of 5 a fter Hunt and Hess died within 24 h due to diencephalic herniation, on e patient of rebleeding. The results of these study suggest early ther apy of SAB with tranexamacid and nimodipin in patients, which are not appropriate for early operation therapy.