The New England journal of medicine
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Randomized Controlled Trial Clinical Trial
Antifibrinolytic treatment in subarachnoid hemorrhage.
We enrolled 479 patients with subarachnoid hemorrhage in a multicenter, randomized, double-blind, placebo-controlled trial to determine whether treatment with the antifibrinolytic agent tranexamic acid improves outcome by preventing rebleeding. At three months there was no statistical difference between the outcomes in the tranexamic acid group and the control group. ⋯ This absence of effect was not due to a lack of antifibrinolytic action, since the rate of rebleeding was reduced from 24 per cent in the control group to 9 per cent in the tranexamic acid-treated group (chi-square = 18.07, P less than 0.001), but resulted from a concurrent increase in the incidence of ischemic complications (15 per cent in the control group and 24 per cent in the tranexamic acid group; chi-square = 8.07, P less than 0.01). We conclude that until some method can be found to minimize ischemic complications, tranexamic acid is of no benefit in patients with subarachnoid hemorrhage.
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Aluminum frequently accumulates in patients with end-stage renal failure. We investigated the value of long-term, intermittent infusions of deferoxamine for the removal of aluminium from bone in seven patients undergoing long-term maintenance dialysis. Transient rises in serum aluminum levels occurred initially after treatment. ⋯ Thus, the test cannot be used to diagnose aluminum accumulation in bone. Urinary aluminum levels increased significantly after a single infusion of deferoxamine in three patients with kidney transplants and accumulation of aluminum in bone. These findings indicate that deferoxamine is beneficial for the therapy of aluminum accumulation in the bone of patients with renal failure.