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, 9 (6), e99536

Risk Factors for Rebleeding of Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis


Risk Factors for Rebleeding of Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis

Chao Tang et al. PLoS One.


Background: Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance.

Methods: A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria.

Results: Higher rebleeding rates were observed < 6 h after the initial aSAH (OR = 3.22, 95% CI = 1.46-7.12), and were associated with high systolic blood pressure (OR = 1.93, 95% CI = 1.31-2.83), poor Hunt-Hess grade (III-IV) (OR = 3.43, 95% CI = 2.33-5.05), intracerebral or intraventricular hematomas (OR = 1.65, 95% CI = 1.33-2.05), posterior circulation aneurysms (OR = 2.15, 95% CI = 1.32-3.49), and aneurysms >10 mm in size (OR = 1.70, 95% CI = 1.35-2.14).

Conclusions: Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Figure 1
Figure 1. Flowchart describing the selection of studies included in the meta-analyses.
Figure 2
Figure 2
Forest plots for the relation between rebleeding and (a) interval time (<6 h) after initial aSAH; (b) systolic blood pressure; (c) Hunt-Hess grade; (d) intracerebral or intraventricular hematomas; (e) location of aneurysms (posterior vs. anterior circulation); (f) aneurysm size (>10 mm).

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Grant support

The authors received no specific funding for this work and have no personal financial or institutional interest in any of the drugs, materials or devices decribed in this article.