[Pharmacologic therapy of subarachnoid hemorrhage]

Medical treatment of subarachnoid haemorrhage, is focused on the prevention of rebleeding and vasospasm, of damages of oxitading products, and on the improvement of general conditions of the patient. Some authors consider use of antifibrinolytic usefull to reduce the risk of rebleeding, but the percentage of hydrocephalus and ischemia are increased. In our Centre combination of nimodipine-cloricromene and hemodilution is used for the prevention of vasospasm. We report conclusions about 216 patients in I-II-III grade of Hunt-Hess scale, treated before 48 hours from SAH. We obtained only 8% postspasm ischemias, with no neurological deficit, and only 23% of increased cerebral blood flow revealed by transcranial Doppler. Cloricromene is used only after aneurysm is occlused. It presents different action mechanisms. It is an inhibitor of platelet activation and aggregation, of cyclooxygenase and lipooxygenase activity, so reducing thromboxanes ratio. Phospholipase A2 inhibition it's possible but not demonstrated. It also interferes with phosphoinositoles path and so with proteinkinase C activity, and reduces hemostatic thrombotic balance activation and leukocyte endothelial adhesion and activation. It reduces, finally, the release of free radicals, cytokines inflammation amplyfing. The reduced damage to the endothelium allows the releasing of vasodilatatory agents like NO.