Benefits of Antifibrinolytic Therapy before Early Aneurysm Surgery
Journal of Korean Neurosurgical Society
;
: 729-733, 2001.
Article
in Korean
| WPRIM
| ID: wpr-71240
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Subarachnoid Hemorrhage
/
Intracranial Aneurysm
/
Brain Ischemia
/
Demography
/
Incidence
/
Cause of Death
/
Hand
/
Hemorrhage
/
Hydrocephalus
/
Hypertension
Type of study:
Incidence study
/
Prognostic study
Limits:
Humans
Language:
Korean
Journal:
Journal of Korean Neurosurgical Society
Year:
2001
Type:
Article
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