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.

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.

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.

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.

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).

Recurrent subarachnoid hemorrhage associated with aminocaproic acid therapy and acute renal artery thrombosis

1979 ◽  
Vol 51 (1) ◽  
pp. 94-97 ◽  
Author(s):  
Raymond R. Tubbs ◽  
Sanford P. Benjamin ◽  
Donald E. Dohn
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Renal Artery ◽  
Aminocaproic Acid ◽  
Clinical Event ◽  
Acid Therapy ◽  
Content Type ◽  
Thrombotic Complications ◽  
Epsilon Aminocaproic Acid ◽  
Fibrin Thrombi ◽  
Fine Print

✓ Epsilon aminocaproic acid (EACA) has been used to prevent rebleeding in patients with subarachnoid hemorrhage (SAH). Although this agent does decrease the frequency of rebleeding, several reports have described thrombotic complications of EACA therapy. These complications have included clinical deterioration and intracranial vascular thrombosis in patients with SAH, arteriolar and capillary fibrin thrombi in patients with fibrinolytic syndromes treated with EACA, or other thromboembolic phenomena. Since intravascular fibrin thrombi are often observed in patients with fibrinolytic disorders, EACA should not be implicated in the pathogenesis of fibrin thrombi in patients with disseminated intravascular coagulation or other “consumption coagulopathies.” This report describes subtotal infarction of the kidney due to thrombosis of a normal renal artery. This occlusion occurred after EACA therapy in a patient with SAH and histopathological documentation of recurrent SAH. The corresponding clinical event was characterized by marked hypertension and abrupt neurological deterioration.

The effect of epsilon aminocaproic acid and tranexamic acid on thrombus size and strength in a simulated arterial aneurysm

1971 ◽  
Vol 34 (3) ◽  
pp. 365-371 ◽  
Author(s):  
Russel H. Patterson ◽  
Peter Harpel
Keyword(s):  
Drinking Water ◽  
Tranexamic Acid ◽  
Abdominal Aorta ◽  
Aminocaproic Acid ◽  
Aortic Pressure ◽  
Arterial Aneurysm ◽  
Content Type ◽  
Antifibrinolytic Drugs ◽  
Epsilon Aminocaproic Acid ◽  
Fine Print

✓ An arterial sac was created in rats by ligating the abdominal aorta, and the size and strength of the thrombus that formed in the sac were studied in the rats whose drinking water contained one of two antifibrolytic agents, 5% epsilon aminocaproic acid (EACA), or 1%, 2.5%, or 5% tranexamic acid (trans-AMCHA). The thrombus in the rats treated with 5% EACA, although no larger, was able to resist an intra-aortic pressure of 80 mm Hg, which was 2.5 times as much as in untreated animals. The weight of the thrombus was the same in rats that received 1% trans-AMCHA as in controls, slightly more in those receiving 2.5% trans-AMCHA, and 2.5 times greater with 5% trans-AMCHA. In the latter group the thrombus could resist an intra-aortic pressure eight times greater than that withstood by the thrombus in control animals. This evidence suggests that treatment with antifibrinolytic drugs may preserve the size and strength of the thrombus in a saccular aneurysm which has recently hemorrhaged.

Myoglobinuria following epsilon-aminocaproic acid (EACA) therapy

1980 ◽  
Vol 53 (5) ◽  
pp. 690-692 ◽  
Author(s):  
Henry M. Brodkin
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Side Effect ◽  
Aminocaproic Acid ◽  
Content Type ◽  
Medical Disorders ◽  
Epsilon Aminocaproic Acid ◽  
Fine Print

✓ Myoglobinuria developed in a patient with subarachnoid hemorrhage treated with a course of 1.43 kg of epsilon-aminocaproic acid (EACA) given over 41 days. Review of eight other cases with a variety of medical disorders shows that this effect occurs after at least 4 weeks of taking doses of a minimum of 24 gm EACA per day. The effect seems to be reversible if discovered early. This side-effect should provide impetus for restricting the duration of EACA therapy to periods under 28 days, in doses no higher than 24 gm/day.

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.

Super giant globoid intracranial aneurysm in an infant

1980 ◽  
Vol 53 (3) ◽  
pp. 411-416 ◽  
Author(s):  
Enrique C. G. Ventureyra ◽  
Sin H. Choo ◽  
Brien G. Benoit
Keyword(s):  
Intracranial Aneurysm ◽  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Posterior Cerebral Artery ◽  
Uneventful Recovery ◽  
Baby Girl ◽  
Content Type ◽  
Two Stages ◽  
Arterial Aneurysms ◽  
Fine Print

✓ The incidence of intracranial aneurysms in infancy is less than 1%. Intracranial arterial aneurysms are very rare in patients under 1 year of age. This 6-month-old baby girl presented with progressive macrocephaly and anemia. Computerized tomography and cerebral angiography demonstrated a giant globoid aneurysm, 8 × 9 cm in size, arising from an anomalous posterior cerebral artery. The aneurysm was successfully clipped and excised in two stages. The child made an uneventful recovery. The congenital nature of the aneurysm is discussed, and the literature concerning intracranial aneurysms in patients under 1 year of age is reviewed.

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