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August 3, 1984

Antifibrinolytics: ischemia may offset control

JAMA. 1984;252(5):595-597. doi:10.1001/jama.1984.03350050003003

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Administering a compound that prevents dissolution of blood clots to a patient who has had a subarachnoid hemorrhage substantially reduces the risk of rebleeding. But the reduction in mortality from rebleeding is almost exactly offset by deaths from ischemia and cerebral infarctions.

These frustrating findings have been verified in two independent studies using two different antifibrinolytic agents. Both studies were reported at the Ninth International Joint Conference on Stroke and Cerebral Circulation in Tampa, Fla. The findings received a mixed reaction from conference participants, some of whom wondered whether fluid restriction might alter the outcomes.

Retrospective Data Discouraging  Neal F. Kassell, MD, who at the time was professor of surgery at the University of Iowa College of Medicine in Iowa City and is now professor of neurosurgery at the University of Virginia School of Medicine in Charlottesville, described results from an uncontrolled retrospective survey of patients enrolled in the Cooperative