Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms

1976 ◽  
Vol 44 (4) ◽  
pp. 479-484 ◽  
Author(s):  
Ram P. Sengupta ◽  
Sing C. So ◽  
Francisco J. Villarejo-Ortega
Keyword(s):  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Preoperative Period ◽  
Preoperative Management ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Similar Series ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms

✓ The authors report their experience with the use of epsilon aminocaproic acid (EACA) in the preoperative management of a series of patients with ruptured intracranial aneurysms. A similar series of patients was taken as control. They found that EACA is of definite value in preventing recurrent hemorrhage in the preoperative period. The significance of antifibrinolytic therapy in ruptured intracranial aneurysms is discussed.

A method for monitoring antifibrinolytic therapy in patients with ruptured intracranial aneurysms

1981 ◽  
Vol 54 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Kim J. Burchiel ◽  
Gottfried Schmer
Keyword(s):  
Fibrinolytic Activity ◽  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms ◽  
Control Plasma ◽  
Fine Print

✓ A rapid fluorometric assay technique has been utilized to assess the degree of fibrinolytic inhibition in 20 patients with ruptured intracranial aneurysms treated with epsilon-aminocaproic acid (EACA). This method quantitates the available plasminogen activity (APA) of plasma, and has proven to be a reliable means of monitoring antifibrinolytic therapy. Determination of the plasma APA also permits correlation of the level of fibrinolytic activity with putative complications of EACA therapy. Normal control plasma APA was 3.1 ± 0.7 CTA units/ml, but in patients with subarachnoid hemorrhage (SAH), pretreatment fibrinolytic activity was supranormal at 3.78 ± 0.88 CTA units/ml. During continuous intravenous administration of EACA (1.5 gm/hr) in patients with SAH, the plasma fibrinolytic activity was decreased to 0.9 ± 0.31 CTA units/ml. A case is described which exemplifies the use of this assay. In addition, an approach to monitoring antifibrinolytic therapy using the plasma APA is proposed.

Epsilon-aminocaproic acid and recurrent subarachnoid hemorrhage

1980 ◽  
Vol 53 (1) ◽  
pp. 28-31 ◽  
Author(s):  
William A. Shucart ◽  
S. K. Hussain ◽  
Paul R. Cooper
Keyword(s):  
Clinical Trial ◽  
Intracranial Aneurysms ◽  
Aminocaproic Acid ◽  
Antifibrinolytic Agents ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Epsilon Aminocaproic Acid ◽  
Arterial Aneurysms ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ A clinical trial of epsilon-aminocaproic acid (EACA) in preventing recurrent hemorrhage from intracranial arterial aneurysms is reported. Previous reports were reviewed, and their results concerning antifibrinolytic agents were inconclusive in establishing their efficacy. One hundred patients with documented ruptured intracranial aneurysms were admitted to this study within 48 hours of the initial hemorrhage: 45 patients received 36 gm of EACA/day, with 11 documented rebleeds and one suspected rebleed; 55 patients did not receive EACA, and there were four documented rebleeds and one suspected rebleed. No benefit was seen from the use of EACA.

Streptokinase clot lysis time in patients with ruptured intracranial aneurysms

1974 ◽  
Vol 40 (4) ◽  
pp. 499-503 ◽  
Author(s):  
Robert Geronemus ◽  
David A. Herz ◽  
Kenneth Shulman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aminocaproic Acid ◽  
Clot Lysis ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Intravenous Treatment ◽  
Lysis Time ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms ◽  
Clot Lysis Time

✓ Antifibrinolytic therapy using epsilon aminocaproic acid (EACA) was administered to 34 patients with subarachnoid hemorrhage, 27 of whom had aneurysms. The streptokinase clot lysis time (SCLT) was used as an index to determine whether patients were receiving adequate doses of medication. Two days of continuous intravenous treatment with 30 to 36 gm per day of EACA were usually required to achieve therapeutic range, as judged by the SCLT. With continued monitoring, doses could then be reduced to as low as 24 gm per day, depending on the requirements of each individual. The authors believe that EACA therapy with SCLT monitoring is valuable in the early conservative treatment of subarachnoid hemorrhage pending definitive aneurysmal surgery.

Preoperative Prognostic Factors for Rebleeding and Survival in Aneurysm Patients Receiving Antifibrinolytic Therapy

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 497-500 ◽  
Author(s):  
James C. Tomer ◽  
Neal F. Kassell ◽  
Robert B. Wallace ◽  
Harold P. Adams
Keyword(s):  
Blood Pressure ◽  
Prognostic Factors ◽  
Intracranial Aneurysms ◽  
Medical Condition ◽  
Neurological Status ◽  
Recurrent Hemorrhage ◽  
Factors Associated ◽  
Antifibrinolytic Therapy ◽  
Pressure Interval ◽  
Ruptured Intracranial Aneurysms

Abstract Prognostic factors for mortality and recurrent hemorrhage in the preoperative, 2-week period were determined in 1114 patients who participated in the antifibrinolytic therapy investigations of the Cooperative Aneurysm Study between 1970 and 1977. Factors significantly related to mortality were admission neurological status, diastolic blood pressure, interval to treatment, degree of vasospasm, and medical condition. Factors associated with the likelihood of recurrent hemorrhage were interval to treatment, patient' sex, and admission neurological status. These factors need to be considered in the analysis of clinical data in the management of ruptured intracranial aneurysms.

Quantitative Determination of Plasma Fibrinolytic Activity in Patients with Ruptured Intracranial Aneurysms Who Are Receiving ϵ-Aminocaproic Acid: Relationship of Possible Complications of Therapy to the Degree of Fibrinolytic Inhibition

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Kim J. Burchiel ◽  
John M. Hoffman ◽  
Roy A. E. Bakay
Keyword(s):  
Fibrinolytic Activity ◽  
Intracranial Aneurysms ◽  
Bleeding Time ◽  
Aminocaproic Acid ◽  
Constant Infusion ◽  
Antifibrinolytic Therapy ◽  
Thrombotic Complications ◽  
Relationship Of ◽  
Ruptured Intracranial Aneurysms

Abstract Fifty-two patients were each given a constant infusion of 1.5 g of ϵ-aminocaproic acid (EACA) per hour after subarachnoid hemorrhage (SAH) from an intracranial aneurysm. Each patient's available plasminogen activity (APA), a measure of plasma fibrinolytic activity, was determined by fluorometric assay before and during EACA treatment. Five categories of potential EACA complications were identified: rebleeding, cerebral vasospasm, hydrocephalus, thrombosis, and miscellaneous (bleeding time prolongation, thrombocytopenia). The APA of the 37 patients with complications was significantly higher than that of the 15 without complications. Four patients suffered rebleeding episodes and had significantly higher APA levels during EACA therapy when compared to all other patients, i.e., those with and without other complications. Patients with vasospasm, hydrocephalus, and thrombotic complications also had significantly higher APA levels during EACA therapy compared to patients without complications. The latter may be simply a reflection of the activation of fibrinolytic activity that occurs after SAH. It is apparent from these studies that, after the initiation of EACA treatment, a maximal steady state inhibition of fibrinolytic activity is not achieved for 2 days and, after the cessation of EACA therapy, normal fibrinolytic activity is not restored for a period of 3 to 4 days. In addition, patients with thrombotic events may show persistently low serum plasminogen activity after discontinuance of EACA therapy, probably due to continuing thrombosis and consumption of plasminogen. These results indicate that patients with recurrent preoperative aneurysmal hemorrhage while on EACA therapy may have inadequate fibrinolytic inactivation, and this may be an important factor contributing to rebleeding episodes. The authors conclude that further studies of patients with SAH from ruptured intracranial aneurysms who are receiving EACA should be done to correlate serum fibrinolytic activity, rebleeding episodes, and other putative complications of antifibrinolytic therapy.

Preoperative management of patients with ruptured intracranial aneurysms

1972 ◽  
Vol 36 (5) ◽  
pp. 525-530 ◽  
Author(s):  
Joseph Ransohoff ◽  
Albert Goodgold ◽  
M. Vallo Benjamin
Keyword(s):  
Cerebral Vasospasm ◽  
Intracranial Aneurysms ◽  
Preoperative Management ◽  
Early Recovery ◽  
Content Type ◽  
Antifibrinolytic Agent ◽  
Definitive Surgery ◽  
Additional Reduction ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ The authors report their experience with the use of an antifibrinolytic agent and hypotensive drugs in the prevention of rebleeding from recently ruptured intracranial aneurysms and conclude that both measures are of suggestive value. With further refinement in these techniques an additional reduction of early rebleeding may be expected. Secondary cerebral vasospasm remains the major obstacle to early recovery and definitive surgery for ruptured intracranial aneurysms.

Monitoring antifibrinolytic therapy in subarachnoid hemorrhage

1973 ◽  
Vol 38 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Robert R. Smith ◽  
John J. Upchurch
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Aminocaproic Acid ◽  
Antifibrinolytic Agents ◽  
Duration Of Action ◽  
Content Type ◽  
The Past ◽  
Fibrin Plate ◽  
Epsilon Aminocaproic Acid ◽  
Ruptured Intracranial Aneurysms

✓ A modification of the fibrin plate method was developed to measure fibrinolysis in patients with subarachnoid hemorrhage and those receiving antifibrinolytic agents. During the past 2 years, 21 patients with ruptured intracranial aneurysms received epsilon aminocaproic acid. Plasma and cerebrospinal fluid were monitored in 15 of these patients. Dosage factors, duration of action, and complications of therapy are presented. Fibrinolysis in normal plasma and cerebrospinal fluid is also discussed.

Cerebral vasospasm following aneurysm rupture

1980 ◽  
Vol 52 (2) ◽  
pp. 149-152 ◽  
Author(s):  
Alan S. Fleischer ◽  
George T. Tindall
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Volume Replacement ◽  
Aneurysm Surgery ◽  
Preoperative Period ◽  
Circulating Blood Volume ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms ◽  
Grade Iii ◽  
Fine Print

✓ A retrospective study was made of 195 patients who had ruptured intracranial aneurysms without significant intracerebral hematomas and who recovered to at least Grade III by Hunt and Hess' classification. The first 121 patients underwent aneurysm surgery 10 days to 2 weeks after subarachnoid hemorrhage (SAH) without repeat preoperative angiography and without special attention to volume replacement or avoidance of hypotension. Vasospasm resulted in cerebral ischemia in 15% of this group, more than half of these postoperatively, and was treated successfully in half the patients with a combination of aminophylline and isoproterenol. The later 74 patients were managed with aggressive maintenance of normal circulating blood volume and preoperative angiography at 2 weeks following SAH. If significant vasospasm persisted on angiography, surgery was delayed an additional week and, if spasm was still present then, aminophylline and isoproterenol were added prophylactically to aggressive volume replacement before surgery. In this second group of patients, the incidence of clinical vasospasm was essentially unchanged; however, it was almost completely limited to the preoperative period, and was more effectively treated with aminophylline and isoproterenol. Postoperative vasospasm was almost completely eliminated from the second group of patients.

Ruptured intracranial aneurysms

1977 ◽  
Vol 46 (3) ◽  
pp. 290-295 ◽  
Author(s):  
Kalmon D. Post ◽  
Eugene S. Flamm ◽  
Albert Goodgold ◽  
Joseph Ransohoff
Keyword(s):  
Blood Pressure ◽  
Intracranial Aneurysms ◽  
Bed Rest ◽  
Aminocaproic Acid ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Surgical Mortality ◽  
Term Survival ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms

✓ The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.

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