At one time, re-hemorrhage was considered a major cause of morbidity and mortality in patients who had survived the initial hemorrhage; however, a shift to early surgical management has minimized the importance of this complication. If unprotected, 15-20% of patients will re-bleed in the first 2 weeks , carrying with it significant mortality and mor bidity. In most studies, there is an initial peak of re-hemorrhage in the first 48 hours of approximately 4%, which rapidly plateaus to 1-2% per day until 40 days post-hemorrhage . After 6 months, there is a long-term risk of further hemorrhage of 3% per year. Approximately half to three-quarters of individuals suffering a re-bleed will die as a direct result and, in the Cooperative Study, re-bleeding was responsible for 25% of all deaths [9,14]. The risk of re-bleed is increased with poor clinical grade, posterior circulation lesions, hypertension, elderly patients and abnormal hemostatic parameters.
Control of blood pressure in order to minimize the risk of re-hemorrhage is a controversial topic. No controlled trial has ever shown that lowering of blood pressure reduces the risk of re-bleeding, although the Cooperative Study revealed that re-bleeds occurred in 16% of patients who had a systolic blood pressure of 170-240 mmHg but only 9% of those with a systolic of 94-169 mmHg. Most clinicians would suggest that extremes of blood pressure should be avoided, high blood pressure being more likely to cause a re-bleed and low blood pressure exacerbating hypoxic or ischemic cerebral damage from vasospasm.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...