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(Stroke. 2008;39:2617.)
© 2008 American Heart Association, Inc.

Research Letters

Impact of a Protocol for Acute Antifibrinolytic Therapy on Aneurysm Rebleeding After Subarachnoid Hemorrhage

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

From the Departments of Neurological Surgery (R.M.S., G.H.K., R.J.K., Z.L.H., M.L.O., A.F.D., C.P.K., D.K.H., M.C., E.S.C.) and Neurology (A.F., S.A.M.), Columbia University, New York, NY.

Correspondence to Ricardo J. Komotar, MD, Department of Neurosurgery, Columbia University, 710 West 168th St, Room 431, New York, NY 10032. E-mail rjk2103{at}columbia.edu

Background and Purpose— -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.

Key Words: aminocaproic acid • antifibrinolytic therapy • rebleeding • aneurysm • subarachnoid hemorrhage