Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage
Document Type
Article
Abstract
BACKGROUND AND PURPOSE: ϵ-Aminocaproic acid (EACA) is an antifibrinolytic agent used to prevent rebleeding in aneurysmal subarachnoid hemorrhage. Although studies have found that a decrease in rebleeding with long-term antifibrinolytic therapy is offset by an increase in ischemic deficits, more recent studies have indicated that early, short-term therapy may be beneficial. METHODS: We instituted a protocol for acute EACA administration starting at diagnosis and continued for a maximum duration of 72 hours after subarachnoid hemorrhage onset. We compared 73 patients treated with EACA with 175 non-EACA-treated patients. We sought to identify differences in the occurrence of rebleeding, side effects, and outcome. RESULTS: Baseline characteristics were similar in the 2 groups. There was a significant decrease in rebleeding in EACA-treated patients (2.7%) versus non-EACA patients (11.4%). There was no difference in ischemic complications between cohorts. There was a significant 8-fold increase in deep venous thrombosis in the EACA group but no increase in pulmonary embolism. There was a nonsignificant 76% reduction in mortality attributable to rebleeding, a 13.3% increase in favorable outcome in good-grade EACA-treated patients, and a 6.8% increase in poor-grade patients. CONCLUSIONS: When used acutely, short-term EACA treatment resulted in decreased rebleeding without an increase in serious side effects in our selected group of patients. Randomized placebo-controlled trials are needed to determine whether acute antifibrinolytic therapy should be accepted as the standard of care in all patients. © 2008 American Heart Association, Inc.
Keywords
Aminocaproic acid, Aneurysm, Antifibrinolytic therapy, Rebleeding, Subarachnoid hemorrhage
Publication Date
9-1-2008
Publication Title
Stroke
ISSN
00392499
Volume
39
Issue
9
First Page
2617
Last Page
2621
PubMed ID
18658042
Digital Object Identifier (DOI)
10.1161/STROKEAHA.107.506097
Recommended Citation
Starke, Robert M.; Kim, Grace H.; Fernandez, Andres; Komotar, Ricardo J.; Hickman, Zachary L.; Otten, Marc L.; Ducruet, Andrew F.; Kellner, Christopher P.; Hahn, David K.; Chwajol, Markus; Mayer, Stephan A.; and Connolly, E. Sander, "Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage" (2008). Translational Neuroscience. 2106.
https://scholar.barrowneuro.org/neurobiology/2106