Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jan 17;1(1):CD013748.
doi: 10.1002/14651858.CD013748.pub2.

Thrombolysis for aneurysmal subarachnoid haemorrhage

Edward R Bader  1 , Mazen M Allam  2 , Thomas Gw Harris  3 , Neena Suchdev  4 , Yoon Kong Loke  5 , Raphae Barlas  6
Affiliations
Meta-Analysis

Thrombolysis for aneurysmal subarachnoid haemorrhage

Edward R Bader et al. Cochrane Database Syst Rev. .

Abstract

Background: Aneurysmal subarachnoid haemorrhage continues to cause a significant burden of morbidity and mortality despite advances in care. Trials investigating local administration of thrombolytics have reported promising results.

Objectives: - To assess the effect of thrombolysis on improving functional outcome and case fatality following aneurysmal subarachnoid haemorrhage - To determine the effect of thrombolysis on the risk of cerebral artery vasospasm, delayed cerebral ischaemia, and hydrocephalus following subarachnoid haemorrhage - To determine the risk of complications of local thrombolysis in aneurysmal subarachnoid haemorrhage SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (last searched 9 March 2023), MEDLINE Ovid (1946 to 9 March 2023), and Embase Ovid (1974 to 9 March 2023). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We performed forward and reverse citation tracking of included studies using Google Scholar.

Selection criteria: We included randomised controlled trials comparing subarachnoid thrombolysis via any route of administration into any anatomical site continuous with the subarachnoid space versus placebo, sham thrombolysis, or standard treatment.

Data collection and analysis: Two review authors independently selected studies for inclusion in the review. We extracted study data and used version 2 of the Cochrane risk-of-bias tool for randomised trials to assess the risk of bias in the studies. We resolved any disagreement through discussion with a third author. Our primary outcome was poor functional outcome. Secondary outcomes were case fatality, haemorrhagic complications, cerebral artery vasospasm, delayed cerebral ischaemia, cerebral infarction, and hydrocephalus. We performed meta-analyses for each outcome and performed sensitivity analysis excluding studies at high risk of bias. We presented results as risk ratios (RRs) with 95% confidence intervals (CIs). We performed further sensitivity analysis by including all intervention groups from studies reporting more than one intervention group. For each outcome, we used the GRADE criteria to determine the certainty of the evidence.

Main results: We included eight studies from six countries in this review. The studies had a total of 410 participants, of whom 205 received thrombolysis. We identified three ongoing trials. We assessed one trial as having a high risk of bias for all outcomes; we assessed the remainder as having a low risk of bias or some concerns. Thrombolysis likely results in a reduction in poor functional outcome when compared to placebo or standard care (29.4% versus 39.7%, RR 0.73, 95% CI 0.56 to 0.94; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis likely results in little to no difference in case fatality (12.8% versus 17.7%, RR 0.71, 95% CI 0.46 to 1.10; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis may result in little to no difference in haemorrhagic complications (10.3% versus 7.2%, RR 1.40, 95% CI 0.73 to 2.68; 6 studies, 341 participants; low-certainty evidence). Thrombolysis likely results in a reduction in cerebral artery vasospasm (32.9% versus 47.6%, RR 0.70, 95% CI 0.54 to 0.91; studies, participants; moderate-certainty evidence), and may result in a reduction in delayed cerebral ischaemia (23.8% versus 38.2%, RR 0.62, 95% CI 0.45 to 0.88; studies, participants; low-certainty evidence). Thrombolysis may result in little to no difference in cerebral infarction (28.6% versus 37.5%, RR 0.76, 95% CI 0.44 to 1.31; studies, participants; low-certainty evidence), and likely results in little to no difference in the risk of hydrocephalus (18.3% versus 24.1%, RR 0.77, 95% CI 0.54 to 1.10; studies, participants; moderate-certainty evidence).

Authors' conclusions: There is some evidence that thrombolysis can probably improve outcomes after aneurysmal subarachnoid haemorrhage, without increasing the risk of haemorrhagic complications. Thrombolysis likely reduces the risk of poor functional outcome and cerebral artery vasospasm, and may reduce the risk of delayed cerebral ischaemia, but it likely makes little to no difference to case fatality or hydrocephalus, and may make little to no difference to the risk of cerebral infarction. However, the current evidence is still uncertain. The uncertainty is primarily due to the small total number of participants and outcome events. Data from further studies are required to confirm the efficacy of thrombolysis for improving outcomes after aneurysmal subarachnoid haemorrhage.

PubMed Disclaimer

Conflict of interest statement

Edward R. Bader: none known

Mazen M Allam: none known

Thomas GW Harris: none known

Neena Suchdev: none known

Yoon Kong K Loke: none known

Raphae Barlas: none known

Update of

  • doi: 10.1002/14651858.CD013748

Similar articles

See all similar articles

References

References to studies included in this review

Etminan 2013 {published data only}
    1. Eicker SO, Beseoglu K, Etminan N, Perrin J, Taskin A, Steiger H, Hänggi D. The effect of intraventricular thrombolysis in combination with low-frequency head motion after severe subarachnoid hemorrhage: interim analysis of safety, clot clearance rate and delayed cerebral ischemia. Acta Neurochirurgica 2012;Supplement 114:323‐8. - PubMed
    1. Etminan N, Beseoglu K, Eicker SO, Turowski B, Steiger HJ, Hänggi D. Prospective, randomized, open-label phase ii trial on concomitant intraventricular fibrinolysis and low-frequency rotation after severe subarachnoid hemorrhage. Stroke 2013;44(8):2162-8. - PubMed
    1. ISRCTN13230264. Concomitant intraventricular fibrinolysis and low-frequency rotation after severe subarachnoid hemorrhage [Prospective, randomized, phase IIb trial on concomitant intraventricular fibrinolysis and low-frequency rotation after severe subarachnoid hemorrhage]. https://www.isrctn.com/ISRCTN13230264 (first received 18 July 2012). - PubMed
Findlay 1995 {published data only}
    1. Findlay JM, Kassell NF, Kongable G, Weir BKA. Double-blinded, placebo-controlled efficacy study of intracisternal recombinant tissue plasminogen activator (rt-PA) in patients with aneurysmal subarachnoid hemorrhage. Canadian Journal of Neurological Sciences 1995;22(2 (Suppl 1)):S30.
    1. Findlay JM, Kassell NF, Weir BK, Haley EC, Kongable G, Germanson T, et al. A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery 1995;37(1):168-78. - PubMed
Hamada 2003 {published data only}
    1. Hamada J, Kai Y, Morioka M, Yano S, Mizuno T, Hirano T, et al. Effect on cerebral vasospasm of coil embolization followed by microcatheter intrathecal urokinase infusion into the cisterna magna: a prospective randomized study. Stroke 2003;34(11):2549-54. - PubMed
Kanamaru 1993 {published data only (unpublished sought but not used)}
    1. Kanamaru K, Waga S, Sakakura M, Morikawa A, Yamamoto Y, Morooka Y, et al. Comparative study of cisternal lavage methods for the treatment of cerebral vasospasm. In: Findlay JM , editors(s). Cerebral Vasospasm: Proceedings of the Fifth International Conference on Cerebral Vasospasm. Amsterdam: Elsevier, 1993:471-4.
Kramer 2014 {published data only}
    1. Kramer AH, Jenne C, Holodinsky JK, Todd S, Robert DJ, Kubes P, et al. Pharmacokinetics and pharmacodynamics of tissue plasminogen activator administered through an external ventricular drain. Neurocritical Care 2015;23:386-93. - PubMed
    1. Kramer AH, Roberts DJ, Holodinsky J, Todd S, Hill MD, Zygun DA, et al. Intraventricular tissue plasminogen activator in subarachnoid hemorrhage patients: a prospective, randomized, placebo-controlled pilot trial. Neurocritical Care 2014;21(2):275-84. - PubMed
    1. Kramer AH, Roberts DJ, Todd S, Holodinsky J, Hil MD, Zygun DA, et al. Intraventricular thrombolysis in aneurysmal subarachnoid hemorrhage: a randomized controlled pilot trial. Neurocritical Care 2013;19(1 SUPPL.1):S9. - PubMed
    1. Kramer AH, Todd S, Holodinsky J, Zygun DA, Hill MD, Wong JH. Pharmacokinetics of intraventricular tissue plasminogen activator in aneurysmal subarachnoid hemorrhage patients. Canadian Journal of Neurological Sciences 2014;41(SUPPL. 1):S49-50.
    1. NCT01098890. Intraventricular tissue plasminogen activator (tPA) in the management of aneurysmal subarachnoid hemorrhage. https://clinicaltrials.gov/ct2/show/NCT01098890 (first received 5 April 2010).
Litrico 2013 {published and unpublished data}
    1. Litrico S, Almairac F, Gaberel T, Ramakrishna R, Fontaine D, Sedat J, et al. Intraventricular fibrinolysis for severe aneurysmal intraventricular hemorrhage: a randomized controlled trial and meta-analysis. Neurosurgical Review 2013;36(4):523-31. - PubMed
    1. NCT00823485. Clinical efficacy of in-situ thrombolysis in case of intraventricular haemorraghia by aneurysm rupture. https://clinicaltrials.gov/ct2/show/NCT00823485 (first received 15 January 2009).
Nieuwkamp 2005 {unpublished data only}
    1. ISRCTN36786212. Intraventricular infusion of rt-PA in severe intraventricular haemorrhage after aneurysmal subarachnoid haemorrhage. A randomised clinical trial [Recombinant tissue plasminogen activator (rt-PA) and external ventricular drain (EVD) in subarachnoid haemorrhage (SAH) with obstructive hydrocephalus for lysis of ventricular blood. A randomised clinical trial]. https://www.isrctn.com/ISRCTN36786212 (first received 27 January 2006).
    1. NTR455. Intraventricular infusion of rt-PA in severe intraventricular haemorrhage after aneurysmal subarachnoid haemorrhage. A randomised clinical trial [rt-PA and EVD in SAH with obstructive hydrocefalus for lysis of ventricular blood. A randomised clinical trial]. https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON28831 (first registered 13 October 2005).
    1. Nieuwkamp D. RESOLVE trial [personal communication]. Email to: ER Bader 15 October 2021.
Yamamoto 2010 {published data only}
    1. Yamamoto T, Esaki T, Nakao Y, Mori K. Efficacy of low-dose tissue-plasminogen activator intracisternal administration for the prevention of cerebral vasospasm after subarachnoid hemorrhage. World Neurosurgery 2010;73(6):675-82. - PubMed

References to studies excluded from this review

EudraCT 2008 {published data only}
    1. EudraCT 2008-008215-25. Behandling ved intraventrikulær blødning: Et pilotstudie af virkningen med tidlig intraventrikulær actilysebehandling. https://www.clinicaltrialsregister.eu/ctr-search/trial/2008-008215-25/re... (start date 5 May 2009).
Gorski 2000 {published data only}
    1. Gorski R, Zabek M, Jarmuzek P. Influence of intraoperative using of recombinant tissue plasminogen activator on the development of cerebral angiospasm after subarachnoid haemorrhage in patients with ruptured intracranial aneurysms. Neurologia i Neurochirurgia Polska 2000;34(6 Suppl):41-7. - PubMed
Hänggi 2009 {published data only}
    1. Hänggi D, Eicker S, Beseoglu K, Behr J, Turowski B, Steiger H-J. A multimodal concept in patients after severe aneurysmal subarachnoid hemorrhage: results of a controlled single centre prospective randomized multimodal phase I/II trial on cerebral vasospasm. Zentralblatt fur Neurochirurgie 2009;70(2):61-7. - PubMed
Kawamoto 2004 {published data only}
    1. Kawamoto S, Tsutsumi K, Yoshikawa G, Shinozaki M, Yako K, Nagata K, Ueki K. Effectiveness of the head-shaking method combined with cisternal irrigation with urokinase in preventing cerebral vasospasm after subarachnoid hemorrhage. Journal of Neurosurgery 2004;100(2):236-43. - PubMed
Kobayashi 2001 {published data only}
    1. Kobayashi S, Satoh A, Koguchi Y, Wada M, Tokunaga H, Miyata A, et al. Clearance of subarachnoid clots after GDC embolization for cutely ruptured cerebral aneurysm. Comparison with early direct surgery. Interventional Neuroradiology 2001;7(Suppl 1):57-60. - PMC - PubMed
Li 2005 {published data only}
    1. Li YH, Guo K, Zi XH, Song Z. Combining exchange of cerebrospinal fluid with small dose of urokinase injection for subarachnoid hemorrhage [Zhong nan da xue xue bao]. Journal of Central South University. Medical Sciences 2005;30(2):217-20. - PubMed
NCT00029315 {published and unpublished data}
    1. NCT00029315. Intraventricular Rt-PA in patients with intraventricular hemorrhage. https://clinicaltrials.gov/ct2/show/NCT00029315 (first received 11 January 2002).
NCT01878136 {published data only}
    1. NCT01878136. Effect of Intraventricular tPA following aneurysmal subarachnoid hemorrhage. https://clinicaltrials.gov/ct2/show/NCT01878136 (first received 14 June 2013).
Nyquist 2007 {published data only}
    1. Nyquist P, Hanley DF. The use of intraventricular thrombolytics in intraventricular hemorrhage. Journal of Neurological Sciences 2007;261(1-2):84-8. - PubMed
Seifert 1994 {published data only}
    1. Seifert V, Stolke D, Zimmermann M, Feldges A. Prevention of delayed ischaemic deficits after aneurysmal subarachnoid haemorrhage by intrathecal bolus injection of tissue plasminogen activator (rTPA). A prospective study. Acta Neurochirurgica 1994;128(1-4):137-43. - PubMed
Sunada 1990 {published data only}
    1. Sunada I, Yamamoto S, Nishimura S. Cisternal irrigation therapy with urokinase. Stroke 1990;21((Suppl 1)):I-71.

References to ongoing studies

CTRI/2022/11/047665 {published data only}
    1. CTRI/2022/11/047665. Randomized placebo-controlled trial of intrathecal clot lysis to reduce vasospasm in aneurysmal subarachnoid hemorrhage. https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzE4ODI=&amp... (first registered 25 November 2022).
FIVHeMA 2019 {published data only}
    1. EUCTR2017-000429-10. FIVHeMA: intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: a randomized controlled trial. https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_nu... (first registered 24 October 2017). - PubMed
    1. Gaberel T, Gakuba C, Fournel F, Le Blanc E, Gaillard C, Peyro-Saint-Paul L, Chaillot F, Tanguy P, Parienti JJ, Emery E. FIVHeMA: Intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: A randomized controlled trial. Neurochirurgie 2019;65(1):14-9. - PubMed
    1. NCT03187405. Intraventricular fibrinolysis for aneurysmal subarachnoid hemorrhage. (FIVHeMA). https://clinicaltrials.gov/ct2/show/NCT03187405 (first posted 15 June 2017).
SPLASH 2021 {published data only}
    1. DRKS00015645. Stereotactic Cisternal Lavage in Patients with AneurysmalSubarachnoid Hemorrhage with Urokinase and Nimodipine for thePrevention of Secondary Brain Injury. A Randomized Controlled Trial. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRI... (date registered 08 May 2019).
    1. EUCTR2017-000868-15-DE. Stereotactic Cisternal Lavage in Patients with Aneurysmal Subarachnoid Hemorrhage with Urokinase and Nimodipine for the Prevention of Secondary Brain Injury. A Randomized Controlled Trial. https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2017-000868-15-DE (date registered 14 June 2017). - PMC - PubMed
    1. Roelz R, Schubach F, Coenen VA, Jenker C, Scheiwe C, Grauvogel J, Niesen WD, Urbach H, Taschner C, Seufert J, Kätzler J, Beck J, Reinacher PC. Stereotactic cisternal lavage in patients with aneurysmal subarachnoid hemorrhage with urokinase and nimodipine for the prevention of secondary brain injury (SPLASH): study protocol for a randomized controlled trial. Trials 2021;22(1):285. - PMC - PubMed

Additional references

Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Connolly 2012
    1. Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke 2012;43(6):1711-37. - PubMed
Docagne 2015
    1. Docagne F, Parcq J, Lijnen R, Ali C, Vivien D. Understanding the functions of endogenous and exogenous tissue-type plasminogen activator during stroke. Stroke 2015;46(1):314-20. - PubMed
Etminan 2013
    1. Etminan N, Beseoglu K, Eicker SO, Turowski B, Steiger H-J, Hanggi D. Prospective, randomized, open-label phase II trial on concomitant intraventricular fibrinolysis and low-frequency rotation after severe subarachnoid hemorrhage. Stroke 2013;44(8):2162-8. - PubMed
Etminan 2019
    1. Etminan N, Chang H-S, Hackenberg K, Rooij NK, Vergouwen MDI, Rinkel GJE, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurology 2019;76(5):588-97. - PMC - PubMed
Feigin 2009
    1. Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurology 2009;8(4):355-69. - PubMed
Findlay 1995
    1. Findlay JM, Kassell NF, Weir BKA, Haley EC, Kongable G, Germanson T, et al. A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery 1995;37(1):168-78. - PubMed
Gaastra 2022
    1. Gaastra B, Ren D, Alexander S, Awad IA, Blackburn S, Dore S, et al. Evidence-based interconversion of the Glasgow Outcome and modified Rankin scales: pitfalls and best practices. Journal of Stroke and Cerebrovascular Diseases 2022;31(12):106845. - PMC - PubMed
Germanwala 2010
    1. Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery Clinics of North America 2010;21(2):263-70. - PubMed
GRADEpro GDT 2015 [Computer program]
    1. GRADEpro GDT. Version accessed 5 October 2020. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available from gradepro.org.
Guyatt 2011
    1. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—imprecision. Journal of Clinical Epidemiology 2011;64(12):1283-93. - PubMed
Hamada 2003
    1. Hamada J, Kai Y, Morioka M, Yano S, Mizuno T, Hirano T, et al. Effect on cerebral vasospasm of coil embolization followed by microcatheter intrathecal urokinase infusion into the cisterna magna: a prospective randomized study. Stroke 2003;34(11):2549-54. - PubMed
Higgins 2024
    1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane, 2024. Available from www.training.cochrane.org/handbook.
Kistka 2013
    1. Kistka H, Dewan MC, Mocco J. Evidence-based cerebral vasospasm surveillance. Neurology Research International 2013;2013:1-6. - PMC - PubMed
Kramer 2011
    1. Kramer AH, Fletcher JJ. Locally-administered Intrathecal thrombolytics following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurocritical Care 2011;14(3):489-99. [DOI: 10.1007/s12028-010-9429-z] - DOI - PubMed
Kramer 2014
    1. Kramer AH, Roberts DJ, Holodinsky J, Todd S, Hill MD, Zygun DA, et al. Intraventricular tissue plasminogen activator in subarachnoid hemorrhage patients: a prospective, randomized, placebo-controlled pilot trial. Neurocritical Care 2014;21(2):275-84. - PubMed
Lantigua 2015
    1. Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, Badjatia N, Agarwal S, et al. Subarachnoid hemorrhage: who dies, and why? Critical Care 2015;19(1):309. - PMC - PubMed
Lim 2019
    1. Lim C, In J. Randomization in clinical studies. Korean Journal of Anesthesiology 2019;72(3):221-32. - PMC - PubMed
Litrico 2013
    1. Litrico S, Almairac F, Gaberel T, Ramakrishna R, Fontaine D, Sedat J, et al. Intraventricular fibrinolysis for severe aneurysmal intraventricular hemorrhage: a randomized controlled trial and meta-analysis. Neurosurgical Review 2013;36(4):523-31. - PubMed
Lu 2019
    1. Lu X, Ji C, Wu J, You W, Wang W, Wang Z, et al. Intrathecal fibrinolysis for aneurysmal subarachnoid hemorrhage: evidence from randomized controlled trials and cohort studies. Frontiers in Neurology 2019;10:885. - PMC - PubMed
Nieuwkamp 2009
    1. Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, Rooij NK, Rinkel GJE. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurology 2009;8(7):635-42. - PubMed
Page 2021
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. - PMC - PubMed
Pluta 2005
    1. Pluta RM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment. Pharmacology and Therapeutics 2005;105(1):23-56. - PubMed
RevMan 2024 [Computer program]
    1. Review Manager (RevMan). Version 7.12.0. The Cochrane Collaboration, 2024. Available at https://revman.cochrane.org.
Rivero‐Arias 2010
    1. Rivero-Arias O, Gray A, Wolstenholme J. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom. Cost Effectiveness and Resource Allocation 2010;8:6. - PMC - PubMed
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. Available from guidelinedevelopment.org/handbook.
Sterne 2019
    1. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. - PubMed
Takeuchi 1991
    1. Takeuchi H, Handa Y, Kobayashi H, Kawano I, Hayashi M. Impairment of cerebral autoregulation during the development of chronic cerebral vasospasm after subarachnoid hemorrhage in primates. Neurosurgery 1991;28(1):41-8. - PubMed
Thilak 2024
    1. Thilak S, Brown P, Whitehouse T, Gautam N, Lawrence E, Ahmed Z, Veenith T. Diagnosis and management of subarachnoid haemorrhage. Nature Communications 2024;15:1850. - PMC - PubMed
Vergouwen 2008
    1. Vergouwen MDI, Vermeulen M, Coert BA, Stroes ESG, Roos YBWEN. Microthrombosis after aneurysmal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia. Journal of Cerebral Blood Flow & Metabolism 2008;28(11):1761-70. - PubMed
Wiebers 2003
    1. Wiebers DO. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362(9378):103-10. - PubMed

References to other published versions of this review

Bader 2020
    1. Bader ER, Allam MM, Harris TGW, Suchdev N, Loke YK, Barlas R. Thrombolysis for aneurysmal subarachnoid haemorrhage. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No: CD013748. [DOI: 10.1002/14651858.CD013748] - DOI - PMC - PubMed

MeSH terms

Substances

LinkOut - more resources