A method for monitoring antifibrinolytic therapy in patients with ruptured intracranial aneurysms

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Abstract
A rapid fluorometric assay technique was utilized to assess the degree of fibrinolytic inhibition in 20 patients with ruptured intracranial aneurysms treated with epsilon-aminocaproic acid (EACA). This method quantitates the available plasminogen activity (APA) and is a reliable means of monitoring antifibrinolytic therapy. Determination of the plasma APA permits correlation of the level of fibrinolytic activity with putative complications of EACA therapy. Normal control plasma APA was 3.1 .+-. 0.7 CTA units/ml. In patients with subarachnoid hemorrhage (SAH), pretreatment fibrinolytic activity was supranormal at 3.78 .+-. 0.88 CTA units/ml. During continuous i.v. administration of EACA (1.5 g/h) in patients with SAH, the plasma fibrinolytic activity was decreased to 0.9 .+-. 0.31 CTA units/ml. A case is described which exemplifies the use of this assay. An approach to monitoring antifibrinolytic therapy using the plasma APA is proposed.