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Summary
Epsilon-aminocaproic acid effectively prevents recurrent hemorrhages after ruptured intracranial aneurysms. Combining this antifibrinolytic drug with subtotal carotid occlusion offers the best treatment strategy.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Pharmacology
Background:
- Subarachnoid hemorrhage from ruptured intracranial aneurysms carries a high risk of rebleeding.
- Antifibrinolytic therapy and surgical interventions are used to prevent rebleeding.
Purpose of the Study:
- To evaluate the efficacy of antifibrinolytic drugs and subtotal carotid occlusion in preventing recurrent hemorrhages in patients with ruptured intracranial aneurysms.
Main Methods:
- A series of 168 patients with recently ruptured intracranial aneurysms were treated with epsilon-aminocaproic acid and/or subtotal carotid occlusion.
- Hypotensive therapy was also considered in patient management.
Main Results:
- Epsilon-aminocaproic acid demonstrated effective treatment for preventing recurrent hemorrhages.
- Aggressive hypotensive therapy was found to be dangerous in severely obtunded patients.
- The combination of epsilon-aminocaproic acid and subtotal carotid occlusion, with moderate hypotensive management, provided the best results in preventing rebleeding.
Conclusions:
- Epsilon-aminocaproic acid is an effective antifibrinolytic agent for managing ruptured intracranial aneurysms.
- Subtotal carotid occlusion, when combined with epsilon-aminocaproic acid and moderate hypotension, represents an optimal treatment strategy for preventing recurrent hemorrhages.