Preoperative treatment of ruptured intracranial aneurysms with tranexamic acid and monitoring of fibrinolytic activity

1980 ◽  
Vol 52 (4) ◽  
pp. 453-455 ◽  
Author(s):  
J. A. Alvarez Garijo ◽  
J. J. Vilches ◽  
J. A. Aznar
Keyword(s):  
Cerebrospinal Fluid ◽  
Tranexamic Acid ◽  
Fibrinolytic Activity ◽  
Intracranial Aneurysms ◽  
Accurate Method ◽  
Preoperative Treatment ◽  
Careful Monitoring ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms

✓ The fibrinolytic activity in cerebrospinal fluid has been monitored by determination of levels of fibrin split products (FSP) in 23 patients with ruptured intracranial aneurysms. In 20 of these 23, FSP was found in the cerebrospinal fluid (CSF), with levels ranging from 10 to 80 μg/ml. Eleven of the 23 patients were treated with 2 gm tranexamic acid daily. In these patients FSP was found in only two cases during the 2nd week, while in 12 untreated patients it was found in 10 cases. These results suggest that there exists a localized fibrinolytic activity, and monitoring the FSP levels in the CSF may be a simple and accurate method for controlling the efficiency of antifibrinolytic therapy. Thus, treatment could be begun with a lower dose, which could be increased later as deemed necessary from the results of careful monitoring.

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.

Cerebral circulation time with ruptured intracranial aneurysms

1974 ◽  
Vol 41 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Shige-Hisa Okawara ◽  
Jun Kimura ◽  
Joo Y. Hahn
Keyword(s):  
Intracranial Aneurysms ◽  
Blood Circulation ◽  
Circulation Time ◽  
Arterial Phase ◽  
Preoperative Treatment ◽  
Content Type ◽  
Arterial Perfusion ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Cerebral Blood Circulation

✓ The cerebral blood circulation time (CT), including the length of the arterial phase, was obtained from rapid serial angiograms in 114 patients with ruptured intracranial aneurysms. The average CT of 7.2 sec, with a mean arterial phase of 3.1 sec, was much longer than the normal average CT of 5.4 sec with its 2.4 sec arterial phase. Longer circulation times were observed with the higher Botterell grades of clinical condition, high arterial perfusion and CSF pressures, and in cases with angiographic evidence of arterial spasm, hematoma, or hydrocephalus. Values of CT greater than 8.0 sec were associated with increased mortality and morbidity and vice versa. The value of the cerebral blood circulation time as a guide to preoperative treatment and to the prognosis of cases of ruptured intracranial aneurysm is suggested.

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.

Ruptured intracranial aneurysms in the first two decades of life

1971 ◽  
Vol 35 (5) ◽  
pp. 571-576 ◽  
Author(s):  
Aneel N. Patel ◽  
Alan E. Richardson
Keyword(s):  
Carotid Artery ◽  
Intracranial Aneurysms ◽  
Postmortem Examination ◽  
Surgical Mortality ◽  
Terminal Portion ◽  
Good Tolerance ◽  
Content Type ◽  
Intracranial Operation ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ An analysis of 3000 ruptured intracranial aneurysms revealed 58 cases in patients under the age of 19 years. There was a striking incidence of aneurysms of the carotid termination and anterior cerebral complex, accounting for 43 of 58 cases, and of these 20 involved the terminal portion of the carotid artery. Vasospasm occurred slightly less often than in adults and infarction was only seen in one postmortem examination. The surgical mortality in alert patients was 7% whereas in a comparable bedrest group it was 38%. This good tolerance to surgery was evident whether intracranial operation or carotid ligation was used, but the surgical method was not randomly allocated.

The risk of rebleeding from ruptured intracranial aneurysms

1987 ◽  
Vol 67 (3) ◽  
pp. 329-332 ◽  
Author(s):  
Jarl Rosenørn ◽  
Vagn Eskesen ◽  
Kaare Schmidt ◽  
Frits Rønde
Keyword(s):  
Mortality Rate ◽  
Life Table ◽  
Intracranial Aneurysms ◽  
Study Group ◽  
Neurosurgical Department ◽  
Content Type ◽  
Life Table Method ◽  
Daily Rate ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ In the 5-year period from 1978 to 1983, 1076 patients with ruptured intracranial aneurysms were admitted to the six neurosurgical departments in Denmark and were entered in a prospective consecutive study conducted by the Danish Aneurysm Study Group. The patients were followed with 3-month and 2-year examinations or to death. A total of 133 patients suffered at least one rebleed after their initial hemorrhage during their first stay in the neurosurgical department; these patients had a mortality rate of 80% compared to 41 % for patients without a rebleed (p < 0.0001). During the first 2 weeks after the initial insult, 102 rebleeds were registered. The daily rate of rebleeds during these 2 weeks, calculated using a life-table method, varied from 0.2% to 2.1%. The rebleed rate during the first 24 hours (Day 0) was 0.8%, and the maximum risk of rebleeding was observed between Day 4 and Day 9. Significantly fewer rebleeds were reported in patients with good clinical grades (Grades 1 to 3, Hunt Grades I and II) compared to those with poor clinical grades (Grades 4 to 9, Hunt Grades III to V: p < 0.001).

Vasoconstrictor activity in cerebrospinal fluid from patients subjected to early surgery for ruptured intracranial aneurysms

1981 ◽  
Vol 55 (2) ◽  
pp. 237-245 ◽  
Author(s):  
David J. Boullin ◽  
Lennart Brandt ◽  
Bengt Ljunggren ◽  
Philip Tagari
Keyword(s):  
Cerebrospinal Fluid ◽  
Content Type ◽  
Vasoactive Substances ◽  
Angiographic Vasospasm ◽  
Close Relationship ◽  
Surgical Adjunct ◽  
Serial Samples ◽  
Subarachnoid Blood ◽  
Ruptured Intracranial Aneurysms ◽  
Isolated Tissues

✓ Vasoconstrictor activity was examined in serial samples of cerebrospinal fluid (CSF) obtained from 10 patients undergoing aneurysm clipping within 48 hours after subarachnoid hemorrhage (SAH). There was no close relationship between vasoconstrictor activity in postoperative CSF samples and the patient's clinical condition or angiographic vasospasm. The identity of the vasoconstrictor substance(s) in CSF was not established, but serotonin, histamine, norepinephrine, epinephrine, acetylcholine, or angiotensinII were eliminated as prime vasoconstrictor agents inducing cerebral vasospasm. Differences in the temporal profile of the responses of isolated tissues to CSF from patients with early and late surgery suggested that differing substances were involved in the production of spasm. A correlation between CSF potassium concentrations and vasoactive substances was found, but potassium could not account for vasoconstrictor activity of CSF. A log:linear correlation between total vasoconstrictor activity and total CSF collected could not be explained. Also, because of possible differences in the identity of vasoactive substances in CSF in this study compared to earlier studies, clinical comparisons based on apparent differences in pharmacological potency of CSF were not warranted. Nevertheless, removal of subarachnoid blood by cisternal rinsing seemed to be a useful surgical adjunct.

Determination of cerebrospinal fluid shunt function with water-soluble contrast medium

1978 ◽  
Vol 49 (3) ◽  
pp. 398-407 ◽  
Author(s):  
Mario Savoiardo ◽  
Carlo L. Solero ◽  
Angelo Passerini ◽  
Franco Migliavacca
Keyword(s):  
Cerebrospinal Fluid ◽  
Contrast Medium ◽  
Water Soluble ◽  
Ventricular Catheter ◽  
Cerebrospinal Fluid Shunt ◽  
Distal Catheter ◽  
Content Type ◽  
Water Soluble Contrast ◽  
Water Soluble Contrast Medium

✓ Determination of cerebrospinal fluid shunt patency with water-soluble contrast medium is a simple, rapid, reliable, and safe technique. Since September, 1974, the authors performed 113 examinations. With the Spitz-Holter valve, only the atrial catheter can be studied, but, with the Pudenz valve and with the shunting devices that have a double-dome reservoir, both the proximal and the distal catheter can be visualized. Through the ventricular catheter a full ventriculographic study can be made, demonstrating ventricular size, malposition of the catheter, and the lesion that caused the hydrocephalus, or its evolution. The problem of collapsed ventricles, in which clinical and “manual” evaluation of the flushing device can give misleading findings, is emphasized. The injection of the atrial or peritoneal catheter in the pathological cases demonstrated its blockage, level of disconnection, malposition, sleeve, or cyst formation. Computerized tomography has only slightly decreased the number of these studies: when the ventricles are large, the examination with water-soluble contrast medium is still needed to demonstrate the exact level of malfunction. This demonstration has decreased the number of the total revisions or complete changes of shunting systems, eliminating some unnecessary changes of normally functioning catheters.

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.

Sign in / Sign up

Export Citation Format

Share Document