Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage

David W. Beck, Harold P. Adams, Eugene S. Flamm, John C. Godersky, Christopher M. Loftus

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Antifibrinolytic drags reduce the risk of rebleeding during the first 2 weeks after aneurysmal sub-arachnoid hemorrhage. However, they do not lower overall mortality, largely because of an increased incidence of cerebral ischemia. The usefulness of antifibrinolytic drugs might be increased if a method to prevent or control vasospasm in patients were to be developed. We recently completed late Phase I and Phase II studies of the calcium ion blocking drug nicardipine in 67 patients treated within 1 week of subarachnoid hemorrhage. Of these 67 patients, 42 had delayed operations and were treated concomitantly with the antifibrinolytic drug aminocaproic add (1.5 g/hr) for an average of 6 days before surgery. The outcome of these 42 patients is the subject of this report. Fifteen of 42 patients were treated with the lower dosage levels of nicardipine (0.4-4.5 mg/m<sup>2</sup>/hr), and 27 patients were treated at the highest dosage level (6.0 mg/m2/hr). Using the World Federation of Neurological Surgeons scale for subarachnoid hemorrhage, at admission 18 patients were Grade 1,15 were Grade II, 6 were Grade HI, and 3 were Grade IV. Five patients (12%) developed clinical signs of deterioration suggestive of cerebral ischemia with concomitant evidence of vasospasm on arteriography. These patients were all treated with hypervolemic hypertensive therapy. Only one patient (2%) developed an Infarction from vasospasm. Two patients developed symptomatic hydrocephalus requiring ventriculo-peritoneal shunting, and a third patient required a temporary ventriculostomy. The 3-month postoperative outcomes were excellent. Three patients (7%) rebled. Three patients died, two from rebleeding of the aneurysm and one who never regained consciousness from the initial hemorrhage. Thirty-two patients (76%) were Grade 1 at 3 months after the subarachnoid hemorrhage. These data suggest that the incidence of vasospasm and cerebral ischemia among patients with antifibrinolytic drugs can be lowered by the concomitant use of a calcium ion blocker. Further investigation of this combination of drugs in patients with recent subarachnoid hemorrhage is warranted.

Original languageEnglish (US)
Pages (from-to)63-67
Number of pages5
JournalStroke
Volume19
Issue number1
StatePublished - 1988
Externally publishedYes

Fingerprint

Aminocaproic Acid
Nicardipine
Subarachnoid Hemorrhage
Antifibrinolytic Agents
Therapeutics
Brain Ischemia
Pharmaceutical Preparations
Ions
Ventriculostomy
Hemorrhage
Arachnoid
Calcium
Patient Admission
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Neuroscience(all)

Cite this

Beck, D. W., Adams, H. P., Flamm, E. S., Godersky, J. C., & Loftus, C. M. (1988). Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage. Stroke, 19(1), 63-67.

Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage. / Beck, David W.; Adams, Harold P.; Flamm, Eugene S.; Godersky, John C.; Loftus, Christopher M.

In: Stroke, Vol. 19, No. 1, 1988, p. 63-67.

Research output: Contribution to journalArticle

Beck, DW, Adams, HP, Flamm, ES, Godersky, JC & Loftus, CM 1988, 'Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage', Stroke, vol. 19, no. 1, pp. 63-67.
Beck, David W. ; Adams, Harold P. ; Flamm, Eugene S. ; Godersky, John C. ; Loftus, Christopher M. / Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage. In: Stroke. 1988 ; Vol. 19, No. 1. pp. 63-67.
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