The Use of Antifibrinolytic Drugs to Prevent Early Recurrent Aneurysmal Subarachnoid Haemorrhage

The purpose of the present study was to investigate the incidence of early recurrent haemorrhage and the survival rate in a series of 34 patients with aneurysmal subarachnoid haemorrhage treated with an antifibrinolytic drug (AMCA) for three weeks. The fibrinolytic activity in blood and CSF from these patients was determined before and at regular intervals during the treatment. The invariably high levels of fibrin degradation products in CSF noted before treatment showed that fibrinolysis was already increased, a finding also made in our previous investigations. Although the present clinical material was relatively small, the data obtained suggest that inhibition of fibrinolysis reduces the incidence of early recurrences during the preoperative period of patients eligible for surgical treatment and those conservatively treated. There were six recurrences in the series, but two of them occurred after the third week of treatment. In both cases the recurrence was ascribed to the fibrinolysis that had started again as soon as AMCA in the CSF was no longer demonstrable. In one patient the recurrence was not associated with increased FDP in CSF, and in the remaining three, the recurrence was presumably due to insufficient inhibition of local fibrinolysis in addition to hypertension. The fact that rebleeding occurred after the third week of treatment suggests the necessity of prolonging the prophylactic antifibrinolytic therapy to six weeks with gradual reduction of the dose of AMCA. During such reduction, however, it is imperative to examine the CSF repeatedly to check that complete inhibition of the local fibrinolysis is maintained. Such prophylactic treatment is useful in the management of cases in which operation must be postponed owing to the patient's poor general condition and in cases allocated to conservative treatment.