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An Examination of Aneurysm Rerupture Rates with Epsilon Aminocaproic Acid
Study Question: Are rerupture rates in aneurysmal subarachnoid hemorrhage (SAH) reduced with the use of epsilon aminocaproic acid (EACA)?
Study Description: The authors conducted a retrospective analysis of patients presenting to a large tertiary academic medical center with aneurysmal SAH over a 2-year period. Patients were categorized based on EACA use and time to presentation. The primary outcome studied was rebleeding rates. EACA was dosed per departmental protocol and patients transferred from outside hospitals received a 5 g IV bolus followed by a 1 g/h drip.
Results: A total of 355 consecutive patients were included in this analysis. Two hundred fifty-one patients treated following an initial rupture within 3 days were included in a subset analysis. After controlling for Hunt and Hess (HH) and Fisher scores, patients were approximately 50% less likely to rerupture after receiving EACA (OR 0.47 and 0.48, respectively) using a fitted model. In the subset group, 3.2% patients without EACA and 1.3% patients with EACA experienced rerupture (p = 0.366). In the subset analysis, there were no differences in thrombotic or ischemic complications (43.3% EACA vs. 41.5% non-EACA) or shunt rates (21% EACA vs. 22.3% non-EACA) between the two groups
Conclusion(s): EACA use may prevent rerupture in some patients but had no significant effect on modified Rankin scores, thrombotic or ischemic complications, or shunt rates in this population. Early aneurysm treatment remains standard of care for SAH patients.
Perspective: This study was undertaken to investigate benefits and risks of early antifibrinolytic treatment in SAH and demonstrated a reduction in aneurysm rerupture with EACA. Previous studies have demonstrated increased shunt placement and thrombotic/ischemic complications with the use of antifibrinolytics. However, recent investigations have shown benefit with early antifibrinolytic use (i.e., < 72 hours following initial rupture) without an increase in ischemic complications. Limitations include selection bias and lack of treatment standardization from outside hospitals.