Aminocaproic Acid in Subarachnoid Hemorrhage

aca aca2

Acute bleeding: Oral, IV: Loading dose: 4-5 g during the first hour, followed by 1 g/hour for 8 hours (or 1.25 g/hour using oral solution) or until bleeding controlled (maximum daily dose: 30 g)


  1. 5 g bolus followed by 1 g/h for a maximum duration of 48 h.
  2. Epsilon amino-caproic acid, dosage probably 24 g per day (6 times 4 g) orally

How does aminocaproic acid work?

ACA binds competitively to plasminogen; blocking the binding of plasminogen to fibrin and the subsequent conversion to plasmin, resulting in inhibition of fibrin degradation (fibrinolysis)

amicar vs tpa MOA ACA TXA

What do the guidelines say about the use of ACA in SAH?

  • shown to reduce incidence of rebleeding with delay in aneurysm obliteration
  • study one center used short-term ACA to prevent rebleeding during patient transfer, results – decreased in rebleeding, no increase in risk of DCI, 3-month clinical outcomes not affected
  • increased risk of DVT but not PE
  • Note:  neither ACA nor TXA is FDA approved for prevention of aneurysm rebleeding

AHA/ASA Guidelines Recommend:

#3 For patients with an unavoidable delay in obliteration of aneurysm, a significant risk of rebleeding, and no compelling medical contraindications, short-term (<72 hours) therapy with tranexamic acid or aminocaproic acid is reasonable to reduce the risk of early aneurysm rebleeding (Class IIa; Level of Evidence B)


Connolly, E. S. et al. ‘Guidelines For The Management Of Aneurysmal Subarachnoid Hemorrhage: A Guideline For Healthcare Professionals From The American Heart Association/American Stroke Association’. Stroke 43.6 (2012): 1711-1737. Web. 15 Oct. 2015.

Foreman, Paul M. et al. ‘Antifibrinolytic Therapy In Aneurysmal Subarachnoid Hemorrhage Increases The Risk For Deep Venous Thrombosis: A Case–Control Study’. Clinical Neurology and Neurosurgery 139 (2015): 66-69. Web. 15 Oct. 2015.,. ‘Aminocaproic Acid’. N.p., 2015. Web. 15 Oct. 2015.

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