TY - THES
T1 - Treatment strategies to improve clinical outcome in aneurysmal subarachnoid hemorrhage
AU - Post, R.
PY - 2022
Y1 - 2022
N2 - After a short introduction of the causes and potential complications of aneurysmal SAH, the first part of this thesis investigates whether antifibrinolytic therapy, reduces the risk of recurrent hemorrhages and leads to an improved clinical outcome, if medication is given early and for a very short time. The clinical outcomes are described from a pooled cohort of two large subarachnoid hemorrhage treatment centers where one center routinely prescribes tranexamic acid (TXA) treatment after aneurysmal SAH and the other treatment center does not. Results from a pragmatic, multicenter, randomized controlled trial whether treatment with ultra-early (<24h) and short-term TXA treatment (max. 24h) could benefit clinical outcome after six months assessed with the modified Rankin Scale score in patients presenting with a SAH. Because recurrent bleeding is only one of the complications that can occur after aneurysmal SAH, part two of this thesis investigates whether other treatment options during hospital admission could improve clinical outcome. We study the effect on clinical outcome of both LMW nadroparin treatment dosing regimens after endovascular (coiling) treatment in aneurysmal SAH. Patients with SAH who are using antiplatelet drugs prior to their hemorrhage, often receive platelet transfusions to reverse antiplatelet effects prior to life-saving surgical interventions. We present a retrospective cohort study of patients who received a transfusion with platelets during hospital admission and explore whether transfusion with platelets negatively influences clinical outcome.
AB - After a short introduction of the causes and potential complications of aneurysmal SAH, the first part of this thesis investigates whether antifibrinolytic therapy, reduces the risk of recurrent hemorrhages and leads to an improved clinical outcome, if medication is given early and for a very short time. The clinical outcomes are described from a pooled cohort of two large subarachnoid hemorrhage treatment centers where one center routinely prescribes tranexamic acid (TXA) treatment after aneurysmal SAH and the other treatment center does not. Results from a pragmatic, multicenter, randomized controlled trial whether treatment with ultra-early (<24h) and short-term TXA treatment (max. 24h) could benefit clinical outcome after six months assessed with the modified Rankin Scale score in patients presenting with a SAH. Because recurrent bleeding is only one of the complications that can occur after aneurysmal SAH, part two of this thesis investigates whether other treatment options during hospital admission could improve clinical outcome. We study the effect on clinical outcome of both LMW nadroparin treatment dosing regimens after endovascular (coiling) treatment in aneurysmal SAH. Patients with SAH who are using antiplatelet drugs prior to their hemorrhage, often receive platelet transfusions to reverse antiplatelet effects prior to life-saving surgical interventions. We present a retrospective cohort study of patients who received a transfusion with platelets during hospital admission and explore whether transfusion with platelets negatively influences clinical outcome.
UR - https://pure.uva.nl/ws/files/67312361/Licentieovereenkomst_medeondertekend_.pdf
UR - https://pure.uva.nl/ws/files/67312363/Uitnodiging.pdf
UR - https://pure.uva.nl/ws/files/67312365/Stellingen.pdf
M3 - Phd-Thesis - Research and graduation internal
SN - 9789464169393
ER -