Antifibrinolytic therapy to prevent early rebleeding after subarachnoid hemorrhage

Mark Chwajol, Robert M. Starke, Grace H. Kim, Stephan A. Mayer, E. Sander Connolly

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

In the current era of early surgery, there has been little interest in the use of antifibrinolytic therapy to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). Older studies demonstrated that antifibrinolytics can reduce rebleeding, but long-term therapy results in increased cerebral ischemia from vasospasm, leading to no appreciable effect on mortality. While early surgery would seem to obviate the need for long-term antifibrinolytic use, a subgroup of patients may benefit from early therapy. The rate of pre-operative rebleeding may be as high as 9-17%, causing significant morbidity and mortality. Short-term use of antifibrinolytic agents (less than 3 days) in the presence of calcium channel blocking therapy has shown promising results. A randomized clinical trial of early antifibrinolytic therapy conducted in 2002 showed a significant decrease in rebleeding and a non-significant decrease in overall mortality. In this review, we examine the clinical pharmacology, dosing, monitoring, complications, and side effects of antifibrinolytic treatment. We conclude that early short-term antifibrinolytic therapy might be a reasonable strategy to prevent acute rebleeding and improve long-term outcome in aSAH patients. Additional randomized clinical trials are necessary to determine whether this management strategy is effective.

Original languageEnglish (US)
Pages (from-to)418-426
Number of pages9
JournalNeurocritical Care
Volume8
Issue number3
DOIs
StatePublished - Jun 2008
Externally publishedYes

Keywords

  • Aminocaproic acid
  • Aneurysm
  • Antifibrinolytics
  • Rebleeding
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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