Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage

Robert M. Starke, Grace H. Kim, Andres Fernandez, Ricardo J Komotar, Zachary L. Hickman, Marc L. Otten, Andrew F. Ducruet, Christopher P. Kellner, David K. Hahn, Markus Chwajol, Stephan A. Mayer, E. Sander Connolly

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: ϵ-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.

Original languageEnglish
Pages (from-to)2617-2621
Number of pages5
JournalStroke
Volume39
Issue number9
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Antifibrinolytic Agents
Subarachnoid Hemorrhage
Aneurysm
Therapeutics
Aminocaproic Acid
Standard of Care
Pulmonary Embolism
Venous Thrombosis
Randomized Controlled Trials
Placebos
Mortality

Keywords

  • Aminocaproic acid
  • Aneurysm
  • Antifibrinolytic therapy
  • Rebleeding
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Starke, R. M., Kim, G. H., Fernandez, A., Komotar, R. J., Hickman, Z. L., Otten, M. L., ... Connolly, E. S. (2008). Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage. Stroke, 39(9), 2617-2621. https://doi.org/10.1161/STROKEAHA.107.506097

Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage. / Starke, Robert M.; Kim, Grace H.; Fernandez, Andres; Komotar, Ricardo J; Hickman, Zachary L.; Otten, Marc L.; Ducruet, Andrew F.; Kellner, Christopher P.; Hahn, David K.; Chwajol, Markus; Mayer, Stephan A.; Connolly, E. Sander.

In: Stroke, Vol. 39, No. 9, 01.09.2008, p. 2617-2621.

Research output: Contribution to journalArticle

Starke, RM, Kim, GH, Fernandez, A, Komotar, RJ, Hickman, ZL, Otten, ML, Ducruet, AF, Kellner, CP, Hahn, DK, Chwajol, M, Mayer, SA & Connolly, ES 2008, 'Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage', Stroke, vol. 39, no. 9, pp. 2617-2621. https://doi.org/10.1161/STROKEAHA.107.506097
Starke, Robert M. ; Kim, Grace H. ; Fernandez, Andres ; Komotar, Ricardo J ; Hickman, Zachary L. ; Otten, Marc L. ; Ducruet, Andrew F. ; Kellner, Christopher P. ; Hahn, David K. ; Chwajol, Markus ; Mayer, Stephan A. ; Connolly, E. Sander. / Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage. In: Stroke. 2008 ; Vol. 39, No. 9. pp. 2617-2621.
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abstract = "BACKGROUND AND PURPOSE: ϵ-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.",
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T1 - Impact of a protocol for acute antifibrinolytic therapy on aneurysm rebleeding after subarachnoid hemorrhage

AU - Starke, Robert M.

AU - Kim, Grace H.

AU - Fernandez, Andres

AU - Komotar, Ricardo J

AU - Hickman, Zachary L.

AU - Otten, Marc L.

AU - Ducruet, Andrew F.

AU - Kellner, Christopher P.

AU - Hahn, David K.

AU - Chwajol, Markus

AU - Mayer, Stephan A.

AU - Connolly, E. Sander

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N2 - BACKGROUND AND PURPOSE: ϵ-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.

AB - BACKGROUND AND PURPOSE: ϵ-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.

KW - Aminocaproic acid

KW - Aneurysm

KW - Antifibrinolytic therapy

KW - Rebleeding

KW - Subarachnoid hemorrhage

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