New Guidelines for Aneurysmal Subarachnoid Bleeds Issued

Transferring of aSAH patients to high-volume centers among the newest recommendations

THURSDAY, May 3 (HealthDay News) -- The latest evidence emphasizes early and aggressive care for emergency room patients diagnosed with aneurysmal subarachnoid hemorrhage (aSAH), according to revised treatment guidelines issued by the American Heart Association (AHA) and the American Stroke Association and published online May 3 in Stroke.

E. Sander Connolly Jr., M.D., chair of the AHA Stroke Council, and colleagues conducted a literature search to derive data-driven recommendations, which were graded using the AHA Stroke Council's algorithm.

The authors identified 21 new recommendations, including five Class 1 recommendations, and made nine changes to earlier recommendations. The guidelines address incidence, risk factors, prevention, and natural history and outcome of aSAH. They also discuss diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, and anesthetic management during repair. Management of aSAH is reviewed, including management of vasospasm and delayed cerebral ischemia, hydrocephalus, seizures, and related medical complications. Some of the newest recommendations include treatment of high blood pressure with antihypertensive medication to prevent ischemic stroke, intracerebral hemorrhage, end-organ injury, and aSAH; administration of oral nimodipine to all patients with aSAH; and early transfer of patients from low-volume hospitals to high-volume centers.

"aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care," the authors write. "Those faced with managing these patients will thus do well to use these guidelines as merely the starting point for doing everything possible to improve the outcomes of patients with aSAH."

Several members of the writing group and reviewers disclosed financial ties to the pharmaceutical and medical device industries.

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