Effect of short-term ϵ-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage

Mahdi Malekpour, Charles Kulwin, Bradley N. Bohnstedt, Golnar Radmand, Rishabh Sethia, Stephen K. Mendenhall, Jonathan Weyhenmeyer, Benjamin K. Hendricks, Thomas Leipzig, Troy D. Payner, Mitesh V. Shah, John Scott, Andrew De Nardo, Daniel Sahlein, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS: All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ϵ-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS: During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95% CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95% CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95% CI 0.031-0.604; p = 0.009) and respiratory insujficiency (OR 0.471, 95% CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS: In this study, short-term EACA treatment in patients who suffered from aSAH and received endovascular aneurysm repair did not decrease the risk of preinterventional rebleeding or increase the risk of thrombotic events. EACA did not affect outcome. Randomized clinical trials are required to provide robust clinical recommendation on shortterm use of EACA.

Original languageEnglish (US)
Pages (from-to)1606-1613
Number of pages8
JournalJournal of Neurosurgery
Volume126
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Aminocaproic Acid
Subarachnoid Hemorrhage
Aneurysm
Therapeutics
Glasgow Outcome Scale
Endovascular Procedures
Antifibrinolytic Agents
Ruptured Aneurysm
Length of Stay
Randomized Controlled Trials
Morbidity

Keywords

  • Cerebral aneurysm
  • Complication
  • Endovascular
  • Outcome
  • Subarachnoid hemorrhage
  • Vascular disorders
  • ϵ-aminocaproic acid

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Effect of short-term ϵ-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage. / Malekpour, Mahdi; Kulwin, Charles; Bohnstedt, Bradley N.; Radmand, Golnar; Sethia, Rishabh; Mendenhall, Stephen K.; Weyhenmeyer, Jonathan; Hendricks, Benjamin K.; Leipzig, Thomas; Payner, Troy D.; Shah, Mitesh V.; Scott, John; De Nardo, Andrew; Sahlein, Daniel; Cohen-Gadol, Aaron.

In: Journal of Neurosurgery, Vol. 126, No. 5, 01.05.2017, p. 1606-1613.

Research output: Contribution to journalArticle

Malekpour, M, Kulwin, C, Bohnstedt, BN, Radmand, G, Sethia, R, Mendenhall, SK, Weyhenmeyer, J, Hendricks, BK, Leipzig, T, Payner, TD, Shah, MV, Scott, J, De Nardo, A, Sahlein, D & Cohen-Gadol, A 2017, 'Effect of short-term ϵ-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage', Journal of Neurosurgery, vol. 126, no. 5, pp. 1606-1613. https://doi.org/10.3171/2016.4.JNS152951
Malekpour, Mahdi ; Kulwin, Charles ; Bohnstedt, Bradley N. ; Radmand, Golnar ; Sethia, Rishabh ; Mendenhall, Stephen K. ; Weyhenmeyer, Jonathan ; Hendricks, Benjamin K. ; Leipzig, Thomas ; Payner, Troy D. ; Shah, Mitesh V. ; Scott, John ; De Nardo, Andrew ; Sahlein, Daniel ; Cohen-Gadol, Aaron. / Effect of short-term ϵ-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage. In: Journal of Neurosurgery. 2017 ; Vol. 126, No. 5. pp. 1606-1613.
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abstract = "OBJECTIVE: Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS: All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ϵ-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS: During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95{\%} CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95{\%} CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95{\%} CI 0.031-0.604; p = 0.009) and respiratory insujficiency (OR 0.471, 95{\%} CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS: In this study, short-term EACA treatment in patients who suffered from aSAH and received endovascular aneurysm repair did not decrease the risk of preinterventional rebleeding or increase the risk of thrombotic events. EACA did not affect outcome. Randomized clinical trials are required to provide robust clinical recommendation on shortterm use of EACA.",
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T1 - Effect of short-term ϵ-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage

AU - Malekpour, Mahdi

AU - Kulwin, Charles

AU - Bohnstedt, Bradley N.

AU - Radmand, Golnar

AU - Sethia, Rishabh

AU - Mendenhall, Stephen K.

AU - Weyhenmeyer, Jonathan

AU - Hendricks, Benjamin K.

AU - Leipzig, Thomas

AU - Payner, Troy D.

AU - Shah, Mitesh V.

AU - Scott, John

AU - De Nardo, Andrew

AU - Sahlein, Daniel

AU - Cohen-Gadol, Aaron

PY - 2017/5/1

Y1 - 2017/5/1

N2 - OBJECTIVE: Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS: All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ϵ-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS: During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95% CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95% CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95% CI 0.031-0.604; p = 0.009) and respiratory insujficiency (OR 0.471, 95% CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS: In this study, short-term EACA treatment in patients who suffered from aSAH and received endovascular aneurysm repair did not decrease the risk of preinterventional rebleeding or increase the risk of thrombotic events. EACA did not affect outcome. Randomized clinical trials are required to provide robust clinical recommendation on shortterm use of EACA.

AB - OBJECTIVE: Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS: All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ϵ-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS: During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95% CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95% CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95% CI 0.031-0.604; p = 0.009) and respiratory insujficiency (OR 0.471, 95% CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS: In this study, short-term EACA treatment in patients who suffered from aSAH and received endovascular aneurysm repair did not decrease the risk of preinterventional rebleeding or increase the risk of thrombotic events. EACA did not affect outcome. Randomized clinical trials are required to provide robust clinical recommendation on shortterm use of EACA.

KW - Cerebral aneurysm

KW - Complication

KW - Endovascular

KW - Outcome

KW - Subarachnoid hemorrhage

KW - Vascular disorders

KW - ϵ-aminocaproic acid

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