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Evidence summaries

Antifibrinolytic Therapy for Aneurysmal Subarachnoid Haemorrhage

Antifibrinolytic treatment does not improve clinical outcome in people after subarachnoid haemorrhage (SAH), although it does reduce the risk of rebleeding. Level of evidence: "A"

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).

    References

    • Baharoglu MI, Germans MR, Rinkel GJ et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2013;8():CD001245. [PubMed].

Primary/Secondary Keywords