title: Short-term tranexamic acid treatment in aneurysmal subarachnoid hemorrhage.
abstract: Antifibrinolytic treatment for 4 weeks after a subarachnoid hemorrhage has been shown to have no effect on outcome since a reduction in the rate of rebleeding was offset by an increase in ischemic events. To determine if a shorter course (4 days) of antifibrinolytic treatment before the expected onset of ischemic complications might reduce the rate of rebleeding yet avoid ischemic complications, we prospectively studied a series of 119 patients with subarachnoid hemorrhage; 479 patients with subarachnoid hemorrhage from our previous randomized double-blind study (238 treated with placebo, 241 with long-term tranexamic acid) served as historical control groups. At 3 months' follow-up, the outcome of patients treated with short-term tranexamic acid was not different from that of patients treated with long-term tranexamic acid. The rate of rebleeding (24 of 119, 20%) was near that with placebo (56 of 238, 24%). In contrast, the rate of cerebral infarction (33 of 119, 28%) was almost identical to that after long-term tranexamic acid (59 of 241, 24%), although mortality from cerebral infarction was reduced. Compared with historical control groups, treatment with tranexamic acid for 4 days fails to reduce the incidence of rebleeding but still increases the rate of cerebral infarction.
authors.affiliation: University Department of Neurology, Utrecht, The Netherlands.
authors.forename: E F
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: D
authors.initials: D
authors.lastname: Hasan
authors.forename: K W
authors.initials: KW
authors.lastname: Lindsay
authors.forename: P J
authors.initials: PJ
authors.lastname: Brouwers
authors.forename: R
authors.initials: R
authors.lastname: Hatfield
authors.forename: G D
authors.initials: GD
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: van Gijn
authors.forename: M
authors.initials: M
authors.lastname: Vermeulen
mesh_terms: D002533:Cerebral Angiography; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D003509:Cyclohexanecarboxylic Acids; D014148:Tranexamic Acid