FIBRINOLYSIS AND SUBARACHNOID HAEMORRHAGE. INHIBITORY EFFECT OF TRANEXAMIC ACIDA Clinical Study

Abstract

In 4 patients with subarachnoid haemorrhage after ruptured intracranial aneurysm, tranexamic acid (AMCA) was used to prevent the recurrence of the bleeding. 1000 mg of AMCA was given intravenously 6 times a day for 8 days. The fibrinolytic activity of blood and spinal fluid was measured simultaneously with the etermination of AMCA levels before and after the beginning of treatment. The fibrin plate method showed no fibrinolytic activity in plasma or in CSF. Local fibriolysis was demonstrated by the presence of fibrin degradation products in spinal fluid. After repeated administration, AMCA crossed the blood‐brain barrier and effectively inhibited the local fibrinolysis within the spinal fluid. The findings in this study suggest that in patients with subarachnoid haemorrhage AMCA should be aministrated intravenously in a dosage of 15–20 mg/kg body weight 6 times a day as soon as possible after the bleeding. But treatment with the antifibrinolytic drug does not change the indication for surgical therapy.

Nimodipine Increases Fibrinolytic Activity in Patients With Aneurysmal Subarachnoid Hemorrhage

“…1 In the past, several studies investigating plasma fibrinolytic activity in patients with SAH did not demonstrate an increase in plasma fibrinolytic activity. [2][3][4] However, in contrast to the results of these older studies, we observed in our study an unexplained 3-week increase in plasma fibrinolytic activity in placebo-treated patients.…”

Cerebral Complication of Antifibrinolytic Therapy in the Treatment of Ruptured Intracranial Aneurysm

“…These gastrointes tinal symptoms were reported in relation to the oral route of administration, however, Fodstad et al (5) reported similar incidence of nausea and vomiting by administering 1 g AMCA i.v. Tovi et al (21) observed that such nausea was obviated by prolongating the injection time to 5-10 min. The causes of such nausea and vomiting have not been clarified.…”

“…In order to prevent the recurrent hemorrhage from aneurysm, accumulation of the antifibrinolytics in cerebrospinal fluid (CSF) is reported es sential (21). If so, this will turn out to be prolonged clot lysis in CSF spaces, then to be increased incidence of hydrocephalus.…”

“…It is not known, however, whether such an epileptogenic effect is specific only to this species of animals or the similar catastrophic phenomenon might be seen in man when using larger doses. Tovi et al (21) suggested that local fibrinolysis in CSF is one of the most important factors in recurrent hemor rhage from aneurysms and stressed the impor tance of successive rise of AMCA level in CSF to prevent recurrent hemorrhage. For this pre ventative purpose, the sufficient concentration of AMCA in CSF was 2 ¡ug/ml.…”

Management of aneurysmal subarachnoid hemorrhage.

“…Both drugs are readily absorbed from the gastrointestinal tract, penetrating the blood-brain barrier and entering the CSF. 31 - 32 The drugs have a short half-life, ranging from 1 to 3 hours. 23 - 3334 The daily dose of EACA, which is the most commonly used drug in the United States, is 24-36 g; that of tranexamic acid, which is most popular in Europe, is around 6 g (4-12 g).…”