This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beck, D. W. Articles by Loftus, C. M. Search for Related Content PubMed PubMed Citation Articles by Beck, D. W. Articles by Loftus, C. M.

Stroke, Vol 19, 63-67, Copyright © 1988 by American Heart Association

ARTICLES

Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage

DW Beck, HP Adams, ES Flamm, JC Godersky and CM Loftus
Division of Neurosurgery, University of Iowa Hospitals, Iowa City 52242.

Antifibrinolytic drugs reduce the risk of rebleeding during the first 2 weeks after aneurysmal subarachnoid hemorrhage. However, they do not lower overall mortality, largely because of an increased incidence of cerebral ischemia. The usefulness of antifibrinolytic drugs might be increased if a method to prevent or control vasospasm in patients were to be developed. We recently completed late Phase I and Phase II studies of the calcium ion blocking drug nicardipine in 67 patients treated within 1 week of subarachnoid hemorrhage. Of these 67 patients, 42 had delayed operations and were treated concomitantly with the antifibrinolytic drug aminocaproic acid (1.5 g/hr) for an average of 6 days before surgery. The outcome of these 42 patients is the subject of this report. Fifteen of 42 patients were treated with the lower dosage levels of nicardipine (0.4-4.5 mg/m2/hr), and 27 patients were treated at the highest dosage level (6.0 mg/m2/hr). Using the World Federation of Neurological Surgeons scale for subarachnoid hemorrhage, at admission 18 patients were Grade I, 15 were Grade II, 6 were Grade III, and 3 were Grade IV. Five patients (12%) developed clinical signs of deterioration suggestive of cerebral ischemia with concomitant evidence of vasospasm on arteriography. These patients were all treated with hypervolemic hypertensive therapy. Only one patient (2%) developed an infarction from vasospasm. Two patients developed symptomatic hydrocephalus requiring ventriculoperitoneal shunting, and a third patient required a temporary ventriculostomy. The 3-month postoperative outcomes were excellent. Three patients (7%) rebled. Three patients died, two from rebleeding of the aneurysm and one who never regained consciousness from the initial hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				Two diagnoses from one electrocardiogram Postgrad. Med. J., September 1, 2001; 77(911): 606f - 606. [Full Text]

				Y. Roos Antifibrinolytic treatment in subarachnoid hemorrhage: A randomized placebo-controlled trial Neurology, January 11, 2000; 54(1): 77 - 77. [Abstract] [Full Text] [PDF]

				E. Bennett-Guerrero, W. F. Spillane, W. D. White, L. H. Muhlbaier, S. A. Gall Jr, P. K. Smith, and M. F. Newman {{varepsilon}}-aminocaproic acid administration and stroke following coronary artery bypass graft surgery Ann. Thorac. Surg., May 1, 1999; 67(5): 1283 - 1287. [Abstract] [Full Text] [PDF]