A Cochrane review 1[Abstract] included 10 studies with a total of 1904 patients with aneurysmal subarachnoid haemorrhage. One trial (n=39) used epsilon-amino-caproic acid, in all others tranexamic acid was used. Four trials (n=1546) reported on poor outcome (death, vegetative state, or severe disability) with a pooled risk ratio (RR) of 1.02 (95%CI 0.91 to 1.15). All trials (n=1904) reported on death from all causes with a pooled RR of 1.00 (95% CI 0.85 to 1.18). In a trial that combined short-term antifibrinolytic treatment (< 72 hours) with preventative measures for cerebral ischaemia the RR for poor outcome was 0.85 (95% CI 0.64 to 1.14). Antifibrinolytic treatment reduced the risk of re-bleeding reported at the end of follow-up (RR 0.65, 95% CI 0.44 to 0.97; 78 per 1000 participants). The pooled RR for reported cerebral ischaemia was 1.41 (95% CI 1.04 to 1.91, 83 per 1000 participants). Antifibrinolytic treatment showed no effect on the reported rate of hydrocephalus in 5 trials (RR 1.11, 95% CI 0.90 to 1.36).
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