Effect of short-term ε-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage.
OBJECTIVE Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ε-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95% CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95% CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95% CI 0.031-0.604; p = 0.009) and respiratory insufficiency (OR 0.471, 95% CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS In this study, short-term EACA treatment in patients who suffered from aSAH and received endovascular aneurysm repair did not decrease the risk of preinterventional rebleeding or increase the risk of thrombotic events. EACA did not affect outcome. Randomized clinical trials are required to provide robust clinical recommendation on short-term use of EACA.
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Mahdi
M
Malekpour
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Charles
C
Kulwin
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Bradley N
BN
Bohnstedt
Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Golnar
G
Radmand
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Rishabh
R
Sethia
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Stephen K
SK
Mendenhall
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Jonathan
J
Weyhenmeyer
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Benjamin K
BK
Hendricks
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Thomas
T
Leipzig
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Troy D
TD
Payner
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Mitesh V
MV
Shah
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
John
J
Scott
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Andrew
A
DeNardo
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.
Daniel
D
Sahlein
Goodman Campbell Brain and Spine, Indiana University, Department of Neurological Surgery.|Indiana University Simon Cancer Center, Indianapolis, Indiana; and.
Aaron A
AA
Cohen-Gadol
D000328:Adult; D000368:Aged; D015119:Aminocaproic Acid / Q000008:administration & dosage*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid
EACA = ε-aminocaproic acid; IQR = interquartile range; RR = risk ratio; TXA = tranexamic acid; aSAH = aneurysmal subarachnoid hemorrhage; cerebral aneurysm; complication; endovascular; outcome; subarachnoid hemorrhage; vascular disorders; ε-aminocaproic acid