Benefits of Antifibrinolytic Therapy before Early Aneurysm Surgery.
- Author:
Jong Moon KIM
1
;
Sung Don KANG
Author Information
1. Department of Neurosurgery, School of Medicine, Wonkwang University, Iksan, Korea.
- Publication Type:Original Article
- Keywords:
Antifibrinolytic therapy;
Subarachnoid hemorrhage;
Rebleeding;
Early aneurysm surgery
- MeSH:
Aneurysm*;
Brain Ischemia;
Cause of Death;
Demography;
Hand;
Hemorrhage;
Humans;
Hydrocephalus;
Hypertension;
Incidence;
Intracranial Aneurysm;
Ischemia;
Subarachnoid Hemorrhage
- From:Journal of Korean Neurosurgical Society
2001;30(6):729-733
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: Antifibrinolytic treatment after aneurysmal subarachnoid hemorrhage has been shown to have no significant effect on outcome since a reduction in the rate of rebleeding was offset by an increase in the incidence of hydrocephalus and ischemic events. As the results of early aneurysm surgery and a change of strategy in the intensive medical treatment, outcome in patients with cerebral ischemia has been improved. On the other hand, rebleeding still remains as a major cause of death. A short course of tranexamic acid(TA) was tried to study its efficacy and safety in reducing the incidence of rebleeding before aneurysm surgery. METHODS: A total of 507 patients with ruptured cerebral aneurysm operated within 3 days after the attack from 1990 to 1999 were included in this study. Group A consisted of 302 consecutive patients treated from 1990 through 1995 served as control. Two hundred-five patients in group B were treated with TA from 1996 through 1999. Both groups were evaluated for comparability of demographic and clinical variables including age, Hunt-Hess grade, Fisher grade, aneurysm location, hypertension, day of surgery, and initial hydrocephalus. The relationships of TA with rebleeding, ischemia, and chronic hydrocephalus were also studied. RESULTS: There was no significant difference in patient demographics and clinical characteristics between group A and group B. Sixteen patients(5.3%) suffered a recurrent hemorrhage in group A and three(1.5%) in group B(p<0.05). Chronic hydrocephalus requiring a shunt was found in a significantly greater proportion in group B than in group A(p<0.05). The incidence of cerebral ischemia was not elevated in group B compared with group A. CONCLUSION: Considering the fact that the reduction of fatal rebleeding outweighed the increased incidence of hydrocephalus, the authors believe that a short course of TA is beneficial in diminishing the risk of rebleeding prior to early surgical intervention.
