Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage.
OBJECTIVE
epsilon-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.
Starke
Robert M
RM
Department of Neurosurgery, Columbia University, 710 West 168th St, Room 431, New York, NY 10032, USA. rjk2103@columbia.edu
Kim
Grace H
GH
Fernandez
Andres
A
Komotar
Ricardo J
RJ
Hickman
Zachary L
ZL
Otten
Marc L
ML
Ducruet
Andrew F
AF
Kellner
Christopher P
CP
Hahn
David K
DK
Chwajol
Markus
M
Mayer
Stephan A
SA
Connolly
E Sander
ES
D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D015119:Aminocaproic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols / Q000592:standards*; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D055502:Secondary Prevention; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid