Acta neurochirurgica
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Acta neurochirurgica · Jan 1982
Review Randomized Controlled Trial Clinical TrialAntifibrinolytic treatment in subarachnoid haemorrhage: present state.
Two randomised controlled clinical trials in patients with recently ruptured intracranial aneurysms were undertaken using tranexamic acid (AMCA) to prevent early recurrent bleeding. In our accumulated series of 105 patients 53 were given AMCA and 52 were controls. 13% of the AMCA-treated patients and 31% of the controls rebled. In patients treated with AMCA the recurrent bleeding took place later than the rebleeding in the control patients. ⋯ Antifibrinolytic agents only appear to reduce the risk of recurrent bleeding during the first ten day period after the primary aneurysm rupture. However they also seem to produce delayed cerebral ischaemia in patients with subarachnoid haemorrhage. Synthetic antifibrinolytics evidently shift the incidence of rebleeding curve to the right but these drugs are probably of diminished value in the subsequent weeks of risk.
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Acta neurochirurgica · Jan 1982
Randomized Controlled Trial Comparative Study Clinical TrialDouble-blind trial of aspirin in patient receiving tranexamic acid for subarachnoid hemorrhage.
Antifibrinolytic agents have been claimed to reduce the rebleed rate in patients with subarachnoid haemorrhage from intracranial aneurysms. However, these agents may in themselves increase the incidence of delayed cerebral ischaemia in these patients. We have used aspirin in an attempt to reduce the incidence of this complication. ⋯ The morbidity and mortality was similar in each group. A further breakdown into patients who had their aneurysms clipped at craniotomy (21 patients) similarly failed to show a more favourable outcome in either group. It is concluded that aspirin does not affect the outcome in patients with subarachnoid haemorrhage treated with tranexamic acid.
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Acta neurochirurgica · Jan 1982
Comparative StudyAntifibrinolytics in aneurysmal subarachnoid haemorrhage. A retrospective comparison of two different forms of antifibrinolytic therapy.
The results of two different antifibrinolytic therapeutic modalities (A = AMCA 3 gm daily + Aprotinin, 3-400000 K. I. ⋯ In these also the incidence of hydrocephalus was decreased, although not significantly (0.20 greater than p greater than 0.19). According to these data, low-dose AMCA + Aprotinin seems to be a rational therapeutic combination for cases of ruptured intracranial aneurysms, in which antifibrinolytics are indicated.
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A case of frontal meningioma harbouring a metastasis from a previously treated breast carcinoma, and a case of metastatic carcinoma into a frontal glioma are reported.
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Acta neurochirurgica · Jan 1981
Randomized Controlled Trial Clinical TrialCoagulation and fibrinolysis in blood and cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: effect of tranexamic acid (AMCA).
Serial assays of blood coagulation factors as well as of fibrin/fibrinogen degradation products (FDP) and plasminogen activatory activity (PA) on fibrin plates in blood and cerebrospinal fluid (CSF) were performed in 41 consecutive patients with recently ruptured cerebral aneurysms, 21 of whom were randomly treated with tranexamic acid (AMCA). Coagulation factors were unaffected by the drug and plasminogen and FDP decreased in blood after two weeks' treatment. ⋯ An increase in CSF-FDP occurred after rebleeding and in patients with cerebral ischaemic symptoms. The results indicate that AMCA inhibits local fibrinolysis in CSF in patients with aneurysm rupture.