THE ASSOCIATION OF TRANEXAMIC ACID AND NIMODIPINE IN THE PREOPERATIVETREATMENT OF RUPTURED INTRACRANIAL ANEURYSMS

In the scope of a late intervention policy on ruptured intracranial an eurysms, on D.+12 on an average, we first used tranexamic acid, at mod erate doses: 3 g orally or 1.5 g intravenously per day. We. subsequent ly, added nimodipine, usually 240 mg orally per day or 2 mg intravenou sly per hour. The medical treatment consisted of amply sufficient hydr ation, and in systematic and regular administration of analgesics and sedatives. Hypotension was absolutely avoided; if necessary, an antihy pertensive treatment was prescribed very cautiously. Phenytoin was reg ularly given. In the present study, we try to answer the following que stions: (1) Can we confirm that the preventive action of tranexamic ac id remains as effective, when doses, markedly lower than usually recom mended, are used? (2) Does nimodipine prevent the increase of pre-oper ative ischaemic complications, which should be expected when tranexami c acid is administered? Amongst 101 patients with SAH of proven aneury smal origin, 84 were treated with tranexamic acid and nimodipine. In 2 5 patients, an aneurysm was not visualised; 21 received this treatment . For several reasons, only a retrospective study was possible, to eva luate the results of our antifibrinolytic and calcium-blocking therapi es, on rebleeding and pre-operative delayed ischaemia. We compared, th erefore, similar cases from the literature, with our own cases, taking into consideration the clinical grades. the days of admission and of intervention, the moment of rebleeding and of delayed pre-operative is chaemia, etc. The following impressions emerge: (1) same effectiveness of moderate doses of tranexamic acid: (2) no increase of pre-operativ e delayed ischaemic complications, in comparison with patients not rec eiving antifibrinolytics but nimodipine; (3) important role of a devas tating initial bleed and of operative complications; (4) difficulty of avoiding rebleeding at D.O, whatever the therapeutic measures, medica l and/or surgical.