TXA Dose: tranexamic acid 1 g IV every 6 h not exceeding 48–72 h
Neither aminocaproic acid nor tranexamic acid is approved by the US Food and Drug Administration for prevention of aneurysm rebleeding.
For patients with an unavoidable delay in obliteration of aneurysm, a significant risk of rebleeding, and no compelling medical contraindications, shortterm (<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). (Revised recommendation from previous guidelines)
An early, short course of antifibrinolytic therapy prior to early aneurysm repair (begun at diagnosis; continued up to the point at which the aneurysm is secured or at 72 h post-ictus, whichever is shorter) should be considered (Low Quality Evidence; Weak Recommendation). •
Delayed (>48 h after the ictus) or prolonged (>3 days) antifibrinolytic therapy exposes patients to side effects of therapy when the risk of rebleeding is sharply reduced and should be avoided (High Quality Evidence; Strong Recommendation). •
Antifibrinolytic therapy is relatively contraindicated in patients with risk factors for thromboembolic complications (Moderate Quality Evidence; Strong Recommendation). •
Patients treated with antifibrinolytic therapy should have close screening for deep venous thrombosis (Moderate Quality Evidence; Strong Recommendation). •
Antifibrinolytic therapy should be discontinued 2 h before planned endovascular ablation of an aneurysm (Very Low Quality Evidence; Weak Recommendation). •
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.
Diringer, Michael N. et al. “Critical Care Management Of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations From The Neurocritical Care Society’S Multidisciplinary Consensus Conference”. Neurocritical Care 15.2 (2011): 211-240.
Sakusic, Amra and Alejandro A. Rabinstein. “Case Studies In Neurocritical Care”. Neurologic Clinics34.3 (2016): 683-697.