Prevention of rebleeding

Around half of people who survive an aneurysmal subarachnoid haemorrhage will have a second bleed from the culprit aneurysm within weeks, and the mortality from a second bleed can exceed 50%

NICE note:

• an interventional neuroradiologist and a neurosurgeon should discuss the options for managing the culprit aneurysm, taking into account the person's clinical condition, the characteristics of the aneurysm, and the amount and location of subarachnoid blood. Options include:
  • endovascular coiling
    • endovascular coiling is less invasive and potentially safer
      • should be offered as the first option, taking factors such as aneurysm characteristics and the amount and location of subarachnoid blood into account
  • neurosurgical clipping
  • no interventional procedure, with monitoring to check for clinical improvement and reassess the options for treatment
    
    
• if interventional treatment is planned, ensure that it is carried out at the earliest opportunity to prevent rebleeding
  • be aware that the risk of rebleeding is highest within 24 hours of the onset of symptoms.

Reference:

• NICE (November 2022).Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management