Wijdicks E F, Hasan D, Lindsay K W, Brouwers P J, Hatfield R, Murray G D, van Gijn J, Vermeulen M
University Department of Neurology, Utrecht, The Netherlands.
Stroke. 1989 Dec;20(12):1674-9. doi: 10.1161/01.str.20.12.1674.
Antifibrinolytic treatment for 4 weeks after a subarachnoid hemorrhage has been shown to have no effect on outcome since a reduction in the rate of rebleeding was offset by an increase in ischemic events. To determine if a shorter course (4 days) of antifibrinolytic treatment before the expected onset of ischemic complications might reduce the rate of rebleeding yet avoid ischemic complications, we prospectively studied a series of 119 patients with subarachnoid hemorrhage; 479 patients with subarachnoid hemorrhage from our previous randomized double-blind study (238 treated with placebo, 241 with long-term tranexamic acid) served as historical control groups. At 3 months' follow-up, the outcome of patients treated with short-term tranexamic acid was not different from that of patients treated with long-term tranexamic acid. The rate of rebleeding (24 of 119, 20%) was near that with placebo (56 of 238, 24%). In contrast, the rate of cerebral infarction (33 of 119, 28%) was almost identical to that after long-term tranexamic acid (59 of 241, 24%), although mortality from cerebral infarction was reduced. Compared with historical control groups, treatment with tranexamic acid for 4 days fails to reduce the incidence of rebleeding but still increases the rate of cerebral infarction.
蛛网膜下腔出血后进行4周的抗纤溶治疗已被证明对预后无影响，因为再出血率的降低被缺血性事件的增加所抵消。为了确定在预期的缺血性并发症发作前进行较短疗程（4天）的抗纤溶治疗是否可能降低再出血率同时避免缺血性并发症，我们前瞻性地研究了一系列119例蛛网膜下腔出血患者；我们之前的随机双盲研究中的479例蛛网膜下腔出血患者（238例接受安慰剂治疗，241例接受长期氨甲环酸治疗）作为历史对照组。在3个月的随访中，短期氨甲环酸治疗患者的预后与长期氨甲环酸治疗患者的预后没有差异。再出血率（119例中的24例，20%）接近安慰剂组（238例中的56例，24%）。相比之下，脑梗死率（119例中的33例，28%）几乎与长期氨甲环酸治疗后的脑梗死率（241例中的59例，24%）相同，尽管脑梗死死亡率有所降低。与历史对照组相比，氨甲环酸治疗4天未能降低再出血的发生率，但仍增加了脑梗死的发生率。
