Intraoperative mild hypothermia for postoperative neurological deficits in intracranial aneurysm patients

Abstract Background Rupture of an intracranial aneurysm causes aneurysmal subarachnoid haemorrhage, which is one of the most devastating clinical conditions. It can be classified into five Grades using the Hunt-Hess or World Federation of Neurological Surgeons (WFNS) scale. Grades 4 and 5 predict poor prognosis and are known as ‘poor grade’, while grade 1, 2, […]

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Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

Abstract Background Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions, as well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and […]

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Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage

Abstract Background Rebleeding is an important cause of death and disability in people with aneurysmal subarachnoid haemorrhage. Rebleeding is probably related to dissolution of the blood clot at the site of aneurysm rupture by natural fibrinolytic activity. This review is an update of a previously published Cochrane review. Objectives To assess the effects of antifibrinolytic […]

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Early versus delayed mobilisation for aneurysmal subarachnoid haemorrhage

Abstract Background Rebleeding is an important cause of death and disability in patients with aneurysmal subarachnoid haemorrhage (SAH). In order to prevent rebleeding, the preferred strategy is aneurysm ablation (removal) as early as possible. However, in clinical practice some patients are not suitable for surgical treatment, or prefer conservative treatments. In some countries, therefore, total […]

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Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage

Abstract Background Cerebral vasospasm and related delayed ischaemic deficits (DIDs) occur in about 17% to 40% of patients with aneurysmal subarachnoid haemorrhage (SAH) and lead to a poor outcome. Cholesterol-reducing agents might improve unfavourable outcomes. Objectives To assess the effects of cholesterol-reducing agents for improving outcomes in patients with aneurysmal SAH. Search methods We searched […]

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Endothelin receptor antagonists for subarachnoid hemorrhage

Abstract Background A subarachnoid hemorrhage (SAH) is a serious and potentially life-threatening condition where blood leaks out of blood vessels over the surface of the brain. Delayed ischemic neurological deficit (DIND) and the related feature of vasospasm, where patients experience a delayed deterioration, have long been recognized as the leading potentially treatable cause of death […]

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Tirilazad for aneurysmal subarachnoid haemorrhage

Abstract Background Delayed cerebral ischaemia is a significant contributor to poor outcome (death or disability) in patients with aneurysmal subarachnoid haemorrhage (SAH). Tirilazad is considered to have neuroprotective properties in animal models of acute cerebral ischaemia. Objectives To assess the efficacy and safety of tirilazad in patients with aneurysmal SAH. Search methods We searched the […]

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Antiplatelet therapy for aneurysmal subarachnoid haemorrhage

Abstract Background Secondary ischaemia is a frequent cause of poor outcome in patients with aneurysmal subarachnoid haemorrhage (SAH). Besides vasospasm, platelet aggregation seems to play a role in the pathogenesis of secondary ischaemia. Experimental studies have suggested that antiplatelet agents can prevent secondary ischaemia. Objectives To determine whether antiplatelet agents change outcome in patients with […]

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Calcium antagonists for aneurysmal subarachnoid haemorrhage

Abstract Background Secondary ischaemia is a frequent cause of poor outcome in patients with subarachnoid haemorrhage (SAH). Its pathogenesis has been incompletely elucidated, but vasospasm probably is a contributing factor. Experimental studies have suggested that calcium antagonists can prevent or reverse vasospasm and have neuroprotective properties. Objectives To determine whether calcium antagonists improve outcome in […]

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Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage

Abstract Background Patients who have had an aneurysmal subarachnoid haemorrhage (SAH) are at very high risk of rebleeding if the aneurysm is not treated. The standard treatment for several decades has been surgical clipping of the neck of the aneurysm. In recent years, an alternative, the introduction of detachable coils to occlude the aneurysm, has […]

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