Acta Neurochirurgica

, Volume 102, Issue 1, pp 1–10

Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms

A double-blind placebo-controlled study
  • S. A. Tsementzis
  • E. R. Hitchcock
  • C. H. A. Meyer
Clinical Articles

DOI: 10.1007/BF01402177

Cite this article as:
Tsementzis, S.A., Hitchcock, E.R. & Meyer, C.H.A. Acta neurochir (1990) 102: 1. doi:10.1007/BF01402177

Summary

One hundred patients with a verified subarachnoid haemorrhage were studied in a double blind, placebo-controlled trial at a single centre to determine the value and relative risks of tranexamic acid (TXA) in the management of ruptured intracranial aneurysms. The incidence of recurrent haemorrhage between active and placebo groups was identical (12%) and the mortality from recurrent haemorrhage was 7% and 5%, respectively. The overall incidence of cerebral infarction before surgery, at discharge and at 6 months follow-up was greater in the TXA group (27%) than in the control group (11%). Post-operative cerebral ischaemia was significantly more frequent in the active, 18 of 29 as compared to 6 of 32 patients, in the placebo group. In a fifth of the patients in whom cerebral blood flow was estimated there was a significant reduction of cerebral blood flow (CBF) on the side of the ruptured aneurysm in the TXA treated group. It is suggested that this may be the cause of the increased incidence of cerebral ischaemia in this group. There was no significant difference in the incidence of cerebral vasospasm, hydrocephalus, visual disturbances and gastrointestinal disturbances.

More fatalities were encountered from ischaemia and recurrent haemorrhage in the TXA group but these differences did not reach statistical significance at the 5% level. Given that disability was due to either vasospasm or recurrent haemorrhage then a patient under TXA treatment was significantly more likely to have disability due to vasospasm (p<0.04); the reverse was true for the placebo patient (p<0.05).

Keywords

Subarachnoid haemorrhageintracranial aneurysmsantifibrinolyticstherapycomplications

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • S. A. Tsementzis
    • 1
  • E. R. Hitchcock
    • 1
  • C. H. A. Meyer
    • 1
  1. 1.University Department of NeurosurgeryBirminghamUK
  2. 2.Ann ArborUSA