Guidelines for the management of aSAH (medical measures to prevent rebleeding)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Mehrsefat, M.D. [2]

2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Medical Measures to Prevent Rebleeding After aSAH: Recommendations

Class I

"1. Between the time of aSAH symptom onset and aneurysm obliteration, blood pressure should be controlled with a titratable agent to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure ( (Level of Evidence: B)"

Class IIa

"1. The magnitude of blood pressure control to reduce the risk of rebleeding has not been established, but a decrease in systolic blood pressure to <160 mm Hg is reasonable (Level of Evidence: C)"

"2. For patients with an unavoidable delay in obliteration of aneurysm, a significant risk of rebleeding, and no compelling medical contraindications, short-term (<72 hours) therapy with tranexamic acid or aminocaproic acid is reasonable to reduce the risk of early aneurysm rebleeding (Level of Evidence: B)"