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.”
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