Antifibrinolytic therapy in ruptured intracranial aneurysm through repeated monitoring of fibrinolytic activity of blood.

Abstract

Streptkinase euglobulin lysis time (SK-ELT), fibrin and fibrinogen degradation products (FDP) and fibrinogen in blood were measured to determine the proper dosage of tAMCHA which would not cause ischemic complications but yet would suffice to prevent rebleeding in ruptured intracranial aneurysm. SK-ELT was almost doubled (130 sec) by the administration of 6-8 g/day of t-AMCHA within 24 h in normal control. On the other hand, SK-ELT in SAH patients fluctuated markedly during ten days after first bleeding. FDP demonstrated high value soon after first bleeding in Grade IV and V patients. Increase in FDP was also observed following rebleeding, severe vasospasm, and progressive neurological deterioration. Usually the increase in FDP was most obvious between 4-14 days after SAH. Fibrinogen showed the tendency to increase gradually by the administration of t-AMCHA, and this increased fibrinogen would be one of the alarm signs to indicate development of ischemic complications. From these results, it was suggested that doses of t-AMCHA should be determined precisely according to the result of repeated monitoring, and doses should be as such that it could keep SK-ELT constant between 130-150 sec.