title: An examination of aneurysm rerupture rates with epsilon aminocaproic acid.
abstract: BACKGROUND
  Epsilon aminocaproic acid (EACA) has been used in the past to prevent cerebral aneurysm rerupture. Recent studies have indicated that short-term treatment with EACA can lower rebleeding rates without significantly increasing ischemic or thrombotic complications or permanent shunt rates. The goal of this study is to determine the efficacy of EACA in the prevention of aneurysm rerupture at a high volume subarachnoid hemorrhage center.
  
  
  METHODS
  We conducted a retrospective study of 355 consecutive subarachnoid hemorrhage patients over a 2-year period under our current protocol for EACA use. Patients were divided by presentation time to our institution and whether the patient received EACA. The primary endpoints of the study were rebleeding rates, ischemic complications, thrombotic complications, vasospasm, shunt rates, and outcomes.
  
  
  RESULTS
  Rerupture rates were reduced by half in the entire pool of patients on EACA after controlling for Hunt and Hess Scores and Fisher Scores. In patients who received early aneurysm treatment, this effect persisted but was non-statistically significant due to the small numbers of reruptures. In addition, there was no evidence to suggest that EACA increased ischemic or thrombotic complications, vasospasm, or VPS rates. In patients presenting earlier than 24 h to our institution, there was a non-significant trend toward worse outcomes after EACA use. This trend was reversed in patients arriving after 24 h.
  
  
  CONCLUSIONS
  There is evidence to suggest that EACA is protective from aneurysm rerupture without significant ischemic or thrombotic complications when used for less than 72 h. However, if the aneurysm is treated, this effect is modest indicating that early aneurysm treatment remains the gold standard for rerupture prevention.
authors: Department of Neurosurgery, Emory University, 1365 Clifton Rd NE Suite 6200, Atlanta, GA 30322, USA. ajschue@gmail.com
authors: Albert J
authors: AJ
authors: Schuette
authors: Ferdinand K
authors: FK
authors: Hui
authors: Nancy A
authors: NA
authors: Obuchowski
authors: Raymond R
authors: RR
authors: Walkup
authors: Charles M
authors: CM
authors: Cawley
authors: Daniel L
authors: DL
authors: Barrow
authors: Owen B
authors: OB
authors: Samuels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D017542:Aneurysm, Ruptured / Q000188:drug therapy* / Q000401:mortality*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid