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Ameneh Eshghinejad: The First 72 Hours After SAH Are Critical for Balancing the Risks of Rebleeding and Thromboembolism
Ameneh Eshghinejad/LinkedIn
Apr 23, 2026, 17:19

Ameneh Eshghinejad: The First 72 Hours After SAH Are Critical for Balancing the Risks of Rebleeding and Thromboembolism

Ameneh Eshghinejad, Intensive Care Nurse at Milad hospital, shared a post on LinkedIn:

”The 72-Hour Rule After SAH… is not just a timeline. It’s a decision that can change a life.

In the ICU, we live in the space between two risks:

Rebleeding… versus Thromboembolism

After an aneurysmal subarachnoid hemorrhage (SAH), the question isn’t if anticoagulation is needed – it’s when it becomes safe enough.

And that’s where many clinicians hesitate.

Here’s the practical bedside approach:

0–24 hours:

No anticoagulation.

Mechanical prophylaxis only (IPC).

Your priority equals protect the brain.

24–48 hours:

Start VTE prophylaxis (low-dose heparin or enoxaparin)

Only if:

  • No active bleeding
  • Imaging is stable

Greater than or equal to 72 hours:

Now we reassess everything.

If the patient is:

  • Aneurysm secured (clipped/coiled)
  • Clinically and radiologically stable
  • No hematoma expansion

This is your green light for therapeutic anticoagulation.

The Bedside Rule you should never forget:

Secured plus Stable plus 72 hours equals Go (carefully)

But here’s the part we don’t always talk about…

I once cared for a patient post-SAH—young, previously healthy.
We delayed anticoagulation, fearing rebleeding.

On day 4, everything looked ‘stable.’
But before escalation… they developed a massive pulmonary embolism.

That moment stays with you.

Because in critical care, waiting is also a decision.
And sometimes… it costs more than acting.

This is why precision matters.

Not just protocols. Not just guidelines.

But clinical judgment, timing, and courage to reassess.”

Ameneh Eshghinejad: The First 72 Hours After SAH Are Critical for Balancing the Risks of Rebleeding and Thromboembolism

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Ameneh Eshghinejad bleeding disorders Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Rebleeding thromboembolism thrombosis
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