====== 🩸 Delayed Bleeding ======

**Delayed bleeding** refers to hemorrhagic events that occur **hours to days after the initial trauma, surgery, or vascular event**, often when the patient is clinically stable or discharged.

===== 🧠 Definition =====
A bleeding episode that is **not present on initial imaging or physical exam**, but appears **after a latent period**, frequently requiring **repeat imaging**, **reintervention**, or **close clinical observation**.

===== ⏱️ Typical Timeframes =====
  * Within **6–72 hours** after:
    * **Mild traumatic brain injury** (especially in anticoagulated patients)
    * **Cranial or spinal surgery**
    * **Endovascular procedures**
    * **Biopsies or shunt placements**

===== ⚠️ Risk Factors =====
  * Anticoagulant or antiplatelet therapy
  * Advanced age (>75 years)
  * Renal failure (affects drug clearance)
  * Inadequate intraoperative hemostasis
  * Unrecognized vascular anomalies

===== 🧠 Neurosurgical Context =====
  * **Delayed intracranial hemorrhage** after a normal initial CT in mild TBI
  * **Epidural or subdural rebleeding** after surgical evacuation
  * **Delayed hemorrhage in tumor bed** post-craniotomy
  * **Spinal epidural hematoma** after lumbar puncture or decompression

===== 🩻 Management =====
  * Maintain **high index of suspicion** if symptoms recur (headache, confusion, vomiting, focal signs)
  * Repeat **cranial imaging** (usually non-contrast CT)
  * Consider ICU observation for high-risk patients even with normal initial imaging
  * Surgical or endovascular intervention if mass effect or clinical deterioration

===== ✅ Best Practice =====
  * Clearly document bleeding risk and timing of last anticoagulant dose
  * Inform patients and families about **symptoms of delayed bleeding**
  * Schedule structured follow-up or control imaging in high-risk scenarios

===== 🔗 Related Entries =====
  * [[clinical_deterioration]]
  * [[anticoagulation_reversal_protocol]]
  * [[dabigatran_reversal_in_mild_traumatic_brain_injury]]
  * [[postoperative_complications]]