Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage

Abstract

BackgroundRebleeding is an important cause of death and disability in people with aneurysmal subarachnoid haemorrhage. Rebleeding is probably related to the dissolution of the blood clot at the site of the aneurysm rupture by natural fibrinolytic activity. This review is an update of previously published Cochrane Reviews. ObjectivesTo assess the effects of antifibrinolytic treatment in people with aneurysmal subarachnoid haemorrhage.

Tranexamic Acid: An Evergreen Hemostatic Agent

“…40 Beside the above-mentioned clinical settings characterized by acute hemorrhage, a recent Cochrane systematic review has assessed the effects of antifibrinolytic treatment in patients with hemorrhages due to subarachnoid aneurysms (11 RCTs included involving 2,717 participants). 41 Although antifibrinolytic drugs reduced the risk of rebleeding (RR: 0.65; 95% CI: 0.47–0.91), no significant effect was observed on mortality. Accordingly, the authors concluded that the routine use of antifibrinolytic drugs in the treatment of aneurysmal subarachnoid hemorrhage is not supported by current evidence.…”

Emerging anesthesia techniques for managing intraoperative rupture of cerebral aneurysms

“…We recommend a target of ≥10 g/dL in the acute phase of IAR. Tranexamic acid. While tranexamic acid reduces rebleeding in patients with SAH, it does not improve overall outcomes 31 . It cannot be recommended for IAR based on currently available evidence. Inspired oxygen fraction (FiO 2 ).…”

“…While tranexamic acid reduces rebleeding in patients with SAH, it does not improve overall outcomes. 31 It cannot be recommended for IAR based on currently available evidence. • Inspired oxygen fraction (FiO 2 ).…”

Emergency Medical Management of Aneurysmal Subarachnoid Hemorrhage

“…The ULtra-early TRranexamic Acid after Subarachnoid Hemorrhage (ULTRA) trial provided convincing evidence that even very early and very short lasting antifibrinolytic therapy does not eliminate the risk of early rebleeding and does not improve functional outcome in patients with aSAH. An updated Cochrane review on this subject concluded that the current evidence does not support the routine use of antifibrinolytic drugs in patients with aSAH [ 22 ]. The recent Neurocritical Care Society guideline also recommends against the administration of antifibrinolytic therapy to prevent rebleeding of ruptured aneurysms in patients with aSAH [ 23 ].…”