Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis: A case-control study

Paul M. Foreman, Michelle Chua, Mark R. Harrigan, Winfield S. Fisher, R. Shane Tubbs, Mohammadali Mohajel Shoja, Christoph J. Griessenauer

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives Aneurysm re-rupture is associated with significant morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). While antifibrinolytics reduce aneurysm re-rupture rates, they have been associated with hydrocephalus, delayed cerebral ischemia, and venous thrombosis. We performed a case-control study in patients enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study to evaluate the impact of short course (<48 h) ε-aminocaproic acid (EACA) on deep venous thrombosis (DVT) rates. Patients and methods A case-control study design was utilized to evaluate the effect of EACA on DVT formation. All cases and controls were obtained from the CARAS study, a prospective, blinded study assessing the association of polymorphisms in the renin angiotensin system and aSAH. Results One hundred and twenty-eight eligible patients were enrolled in CARAS. Overall, 48 (37.5%) patients were screened for DVT, 57 (44.5%) patients were treated with short course (<48 h) EACA, and 8 (6.3%) patients suffered a re-rupture (4 treated with EACA). Ten patients (7.8%) were diagnosed with DVT as evidenced by Doppler US and represent the cases. Twenty controls without evidence of a DVT matched for age, sex, race, tobacco history, Hunt-Hess score, Fisher grade, body mass index, and length of stay were identified from the remaining pool of 118 patients. EACA was found to significantly increase the risk of DVT formation in patients with aSAH (OR 8.49, CI 1.27-77.1). Conclusion Short course (<48 h) administration of EACA in patients with aneurysmal subarachnoid hemorrhage is associated with an 8.5 times greater risk of DVT formation.

Original languageEnglish (US)
Pages (from-to)66-69
Number of pages4
JournalClinical Neurology and Neurosurgery
Volume139
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Antifibrinolytic Agents
Subarachnoid Hemorrhage
Venous Thrombosis
Case-Control Studies
Renin-Angiotensin System
Intracranial Aneurysm
Therapeutics
Rupture
Aneurysm
Aminocaproic Acid
Intracranial Thrombosis
Hydrocephalus
Brain Ischemia
Tobacco
Length of Stay
Body Mass Index
History
Prospective Studies
Morbidity

Keywords

  • Aneurysmal subarachnoid hemorrhage
  • Antifibrinolytic
  • Deep venous thrombosis
  • ε-Aminocaproic acid

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis : A case-control study. / Foreman, Paul M.; Chua, Michelle; Harrigan, Mark R.; Fisher, Winfield S.; Tubbs, R. Shane; Mohajel Shoja, Mohammadali; Griessenauer, Christoph J.

In: Clinical Neurology and Neurosurgery, Vol. 139, 01.12.2015, p. 66-69.

Research output: Contribution to journalArticle

Foreman, Paul M. ; Chua, Michelle ; Harrigan, Mark R. ; Fisher, Winfield S. ; Tubbs, R. Shane ; Mohajel Shoja, Mohammadali ; Griessenauer, Christoph J. / Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis : A case-control study. In: Clinical Neurology and Neurosurgery. 2015 ; Vol. 139. pp. 66-69.
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abstract = "Objectives Aneurysm re-rupture is associated with significant morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). While antifibrinolytics reduce aneurysm re-rupture rates, they have been associated with hydrocephalus, delayed cerebral ischemia, and venous thrombosis. We performed a case-control study in patients enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study to evaluate the impact of short course (<48 h) ε-aminocaproic acid (EACA) on deep venous thrombosis (DVT) rates. Patients and methods A case-control study design was utilized to evaluate the effect of EACA on DVT formation. All cases and controls were obtained from the CARAS study, a prospective, blinded study assessing the association of polymorphisms in the renin angiotensin system and aSAH. Results One hundred and twenty-eight eligible patients were enrolled in CARAS. Overall, 48 (37.5{\%}) patients were screened for DVT, 57 (44.5{\%}) patients were treated with short course (<48 h) EACA, and 8 (6.3{\%}) patients suffered a re-rupture (4 treated with EACA). Ten patients (7.8{\%}) were diagnosed with DVT as evidenced by Doppler US and represent the cases. Twenty controls without evidence of a DVT matched for age, sex, race, tobacco history, Hunt-Hess score, Fisher grade, body mass index, and length of stay were identified from the remaining pool of 118 patients. EACA was found to significantly increase the risk of DVT formation in patients with aSAH (OR 8.49, CI 1.27-77.1). Conclusion Short course (<48 h) administration of EACA in patients with aneurysmal subarachnoid hemorrhage is associated with an 8.5 times greater risk of DVT formation.",
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T1 - Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis

T2 - A case-control study

AU - Foreman, Paul M.

AU - Chua, Michelle

AU - Harrigan, Mark R.

AU - Fisher, Winfield S.

AU - Tubbs, R. Shane

AU - Mohajel Shoja, Mohammadali

AU - Griessenauer, Christoph J.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives Aneurysm re-rupture is associated with significant morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). While antifibrinolytics reduce aneurysm re-rupture rates, they have been associated with hydrocephalus, delayed cerebral ischemia, and venous thrombosis. We performed a case-control study in patients enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study to evaluate the impact of short course (<48 h) ε-aminocaproic acid (EACA) on deep venous thrombosis (DVT) rates. Patients and methods A case-control study design was utilized to evaluate the effect of EACA on DVT formation. All cases and controls were obtained from the CARAS study, a prospective, blinded study assessing the association of polymorphisms in the renin angiotensin system and aSAH. Results One hundred and twenty-eight eligible patients were enrolled in CARAS. Overall, 48 (37.5%) patients were screened for DVT, 57 (44.5%) patients were treated with short course (<48 h) EACA, and 8 (6.3%) patients suffered a re-rupture (4 treated with EACA). Ten patients (7.8%) were diagnosed with DVT as evidenced by Doppler US and represent the cases. Twenty controls without evidence of a DVT matched for age, sex, race, tobacco history, Hunt-Hess score, Fisher grade, body mass index, and length of stay were identified from the remaining pool of 118 patients. EACA was found to significantly increase the risk of DVT formation in patients with aSAH (OR 8.49, CI 1.27-77.1). Conclusion Short course (<48 h) administration of EACA in patients with aneurysmal subarachnoid hemorrhage is associated with an 8.5 times greater risk of DVT formation.

AB - Objectives Aneurysm re-rupture is associated with significant morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). While antifibrinolytics reduce aneurysm re-rupture rates, they have been associated with hydrocephalus, delayed cerebral ischemia, and venous thrombosis. We performed a case-control study in patients enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study to evaluate the impact of short course (<48 h) ε-aminocaproic acid (EACA) on deep venous thrombosis (DVT) rates. Patients and methods A case-control study design was utilized to evaluate the effect of EACA on DVT formation. All cases and controls were obtained from the CARAS study, a prospective, blinded study assessing the association of polymorphisms in the renin angiotensin system and aSAH. Results One hundred and twenty-eight eligible patients were enrolled in CARAS. Overall, 48 (37.5%) patients were screened for DVT, 57 (44.5%) patients were treated with short course (<48 h) EACA, and 8 (6.3%) patients suffered a re-rupture (4 treated with EACA). Ten patients (7.8%) were diagnosed with DVT as evidenced by Doppler US and represent the cases. Twenty controls without evidence of a DVT matched for age, sex, race, tobacco history, Hunt-Hess score, Fisher grade, body mass index, and length of stay were identified from the remaining pool of 118 patients. EACA was found to significantly increase the risk of DVT formation in patients with aSAH (OR 8.49, CI 1.27-77.1). Conclusion Short course (<48 h) administration of EACA in patients with aneurysmal subarachnoid hemorrhage is associated with an 8.5 times greater risk of DVT formation.

KW - Aneurysmal subarachnoid hemorrhage

KW - Antifibrinolytic

KW - Deep venous thrombosis

KW - ε-Aminocaproic acid

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