["Ultra-early" antifibrinolytic treatment of subarachnoidal bleeding with tranexamic acid]

Abstract

Rebleeding is the biggest risk for patients suffering from subarachnoidal bleeding (SAH) from a ruptured aneurysm, and many resources are spent on early diagnosis and closure of the aneurysm with clip or coils. Recent studies have indicated that the risk of rebleeding is significantly greater in the initial six hours after the first bleeding, i.e., prior to possible closure of the aneurysm. A new prospective randomised study from Sweden indicates that antifibrinolytic treatment with tranexamic acid reduced the incidence of these ultra-early rebleedings from 10.8% to 2.4% and that almost all of this effect was obtained within the first few hours after primary hospital admission. Tranexamic acid treatment was without side effects and was given in standard doses until closure of the aneurysm or alternatively up to three days after the initial bleeding. Naturally, this new treatment has focused on the ultra-early phase of the SAH disease with its enforced acute hospitalization for nonpostponable diagnosis and tranexamic acid treatment. Its implementation is a task for neurosurgical departments in collaboration with regional hospitals and the primary sector.