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Jeffrey A. Brown, Robert L. Wollmann and Sean Mullan

of degeneration adjoining regenerating fibers − − Brown, et al. , 1982 72, F 22 36 900 29,800 1027 627 415 46 26 44 + proximal arm followed by leg & truncal weakness + necrotic fibers, all at same stage of necrosis; no inflammatory infiltrate − + mean  41 48 26 1200 16,029 1150 578 1148 30 45 45 4/16 9/16 3/16 6/16 5/19 3/19 * Of the 19 cases, presenting symptoms were fully described in only 16. EACA = epsilon-aminocaproic acid; CPK = creatine phosphokinase

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William A. Shucart, S. K. Hussain and Paul R. Cooper

T he major threat to a patient awaiting definitive aneurysm surgery is recurrent hemorrhage. Antifibrinolytic agents are being used with increasing frequency in an attempt to decrease the incidence of rebleeding, but their efficacy has not been proven. Some reports suggest that antifibrinolytic agents (epsilon-aminocaproic acid (EACA) and tranexamic acid) are effective in preventing recurrent bleeding from aneurysms. 2, 3, 5, 8, 10–12, 14, 16 Most of the studies, however, have had one or more faults: lack of blinding, inadequate randomization, lack of

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Alex R. MacKay, Hoi Sang U and Philip R. Weinstein

A ntifibrinolytic therapy after subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm has become routine in many neurosurgical centers. Epsilon-aminocaproic acid (EACA) has been shown both to reduce the incidence of recurrent hemorrhage before surgical treatment, 7 and to postpone the period of greatest risk of recurrent hemorrhage. 5 However, thrombotic 2, 10 as well as possible arteriopathic 11 complications of EACA therapy have been described. The development of myopathy following treatment with EACA has also been reported but only in

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Susan S. Fish, Salvador Pancorbo and Robert Berkseth

. Four-vessel cranial angiography showed a small aneurysm at the origin of the right posterior communicating artery. The patient was treated with peritoneal dialysis to avoid the heparinization required by hemodialysis. Epsilon-aminocaproic acid therapy was administered until just prior to surgery 12 days later. At surgery, the ruptured aneurysm was successfully clipped. EACA Administration . Aminocaproic acid was administered by continuous intravenous infusion using an IVAC infusion pump. * Initially, 36 gm of EACA per day was administered in D 5 W (dextrose in

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Volker K. H. Sonntag and Bennett M. Stein

, to provide protection against recurrent hemorrhage while fibrous tissue formation and endothelial repair are taking place. It is also well known that elevated fibrinolytic activity in vivo is a major contributing factor to the severe hemorrhage observed in a variety of pathological states, including cirrhosis, hemophilia, and carcinoma of the prostate. Epsilon-aminocaproic acid (Amicar * ) has been shown to inhibit fibrinolysis in vitro, 2, 3, 23 and has been used clinically. 1, 4, 10 Its use in the preoperative treatment of ruptured intracranial aneurysms has

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Henry M. Brodkin

months later. Discussion Epsilon-aminocaproic acid (EACA) (C 5 H 13 NO 2 ) is an acid of low molecular weight (119) that resembles lysine. The EACA is rapidly absorbed after oral and intravenous administration, and is excreted 60% to 90% unmetabolized at approximately 75% of the glomerular filtration rate. 2 The drug acts by inhibiting both plasminogen and plasmin, which are agents active in promoting clot lysis. The level needed to inhibit plasminogen, 13 mg/100 ml, is achieved at a dose of 24 gm/day in a patient with normal renal function. Therefore, use of

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Ram P. Sengupta, Sing C. So and Francisco J. Villarejo-Ortega

management, including bed rest, sedation, and hypotensive therapy, have been advocated but they have not been shown to be of value. The following report is a study of the value of epsilon aminocaproic acid (EACA) in preventing recurrent hemorrhage in two concurrent series of patients who suffered from ruptured intracranial aneurysm, one of which received EACA after a diagnosis of subarachnoid hemorrhage was confirmed by lumbar puncture. Clinical Material We reviewed the case histories of 142 patients with subarachnoid hemorrhage (SAH) and angiographic demonstration

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Tom Ewald, Steve Mahaley Jr., Jack Goodrich, Robert Wilkinson and Don Silver

T he use of epsilon-aminocaproic acid (EACA) has been postulated as an adjunctive measure in the treatment of patients with subarachnoid hemorrhage from aneurysms. This drug is an antifibrinolytic agent and, by preventing perianeurysmal clot lysis, might prevent rebleeding. Norlén and Thulin 10 have reported using EACA for this purpose with apparent success. They reported no rebleeding during treatment for up to 16 days prior to surgery. Two postoperative deaths occurred, one of which was due to bilateral anterior cerebral artery thrombosis 10 days following

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Russel H. Patterson Jr. and Peter Harpel

prevent recurrent hemorrhage. The present report describes the evolution in strength and size of the thrombus that forms in a blind arterial sac created in the rat and how the administration of the antifibrionolytic agents, epsilon aminocaproic acid (EACA) and tranexamic acid (trans-AMCHA; trans-4 amino-methylcyclohexane-1-carboxylic acid) modify the process. Material and Methods Pairs of rats of Sprague-Dawley stock were matched for weight within 10 gm over a range of 230 to 290 gm. One of each pair received drinking water containing either 5% EACA, 1% trans

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Kim J. Burchiel and Gottfried Schmer

T he administration of inhibitors of fibrinolysis to patients with ruptured intracranial aneurysms has proven to be an effective means of reducing the risk of preoperative rebleeding. 8, 14, 17, 19, 23, 25, 26, 30, 32 The most widely used drug, epsilon-aminocaproic acid (EACA), has varying effects in different individuals. 16, 27 Furthermore, there are known complications of this therapy when used in patients with disseminated intravascular coagulation (DIC) and postpartum or postoperative hemorrhage. 2, 4, 9, 11, 13, 15, 18, 29 There is also suggestive