Journal article
Antifibrinolytic Therapy for Prevention of Recurrent Aneurysmal Subarachnoid Hemorrhage
Seminars in neurology, Vol.6(3), pp.309-315
09/1986
DOI: 10.1055/s-2008-1041475
PMID: 3332435
Abstract
Aminocaproic acid and tranexamic acid remain useful adjuncts in treatment. The risk of recurrent bleeding is reduced. No other medical measures are as effective in reducing the risk of rebleeding. Treatment with antifibrinolytic drugs should be started within 7 days of SAH. Rebleeding is most likely in the first few days after the event. If a patient is not seen until 1 week after SAH, the reduced rate of rebleeding does not justify the risk of ischemia associated with the use of antifibrinolytic drugs. In addition, the period of 7 to 10 days after SAH is the time of highest risk of secondary cerebral ischemia. Antifibrinolytic drugs can be administered for 7 to 21 days after SAH or until intracranial operation. The drugs should be continued until the time of surgery; there is no reason to stop the medication 12 to 24 hours before operation. The dosage of drugs does not need to be tapered over several days at the end of the treatment period. The optimal dose of aminocaproic acid is not known. Serum levels of 130 μg/ml are required to reduce blood fibrinolytic activity. It is assumed that comparable CSF levels are necessary. To achieve a therapeutic level of aminocaproic acid rapidly, an intravenous bolus of 5 to 10 gm should be administered followed by a continuous intravenous infusion of approximately 500 mg/kg/day. The rapid achievement of therapeutic levels of drug may reduce the early peak of rebleeding. Aminocaproic acid and tranexamic acid should not be given orally during the first week after SAH because the delay in reaching adequate blood and CSF levels will negate a possible therapeutic response.
Details
- Title: Subtitle
- Antifibrinolytic Therapy for Prevention of Recurrent Aneurysmal Subarachnoid Hemorrhage
- Creators
- Harold Adams
- Resource Type
- Journal article
- Publication Details
- Seminars in neurology, Vol.6(3), pp.309-315
- DOI
- 10.1055/s-2008-1041475
- PMID
- 3332435
- ISSN
- 0271-8235
- eISSN
- 1098-9021
- Language
- English
- Date published
- 09/1986
- Academic Unit
- Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984020892402771
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