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June 1982

Antifibrinolytic Therapy

Author Affiliations

Department of Neurology University Hospital Dijkzigt Rotterdam, the Netherlands
Department of Neurology University Hospital Wilhelmina Gasthuis Amsterdam, the Netherlands

Arch Neurol. 1982;39(6):384. doi:10.1001/archneur.1982.00510180062019

To the Editor.—  Adams et al, in their article "Antifibrinolytic Therapy in Patients With Aneurysmal Subarachnoid Hemorrhage" (Archives 1981;38:25-29), reported on the effect of this treatment in an impressive number of patients. The authors concluded that antifibrinolytic therapy reduces the frequency of rebleeding during the first two weeks, after finding a 10% rebleeding incidence in 1,114 patients treated within eight days from the initial hemorrhage.We criticize this conclusion on two counts. First, before drawing comparisons with another group of patients treated without antifibrinolytic therapy, variables such as time of admission, clinical condition, and the number of days at risk must be matched. The authors themselves demonstrated that these variables are important determinants in the rebleeding incidence. Second, the authors compare their results with a group of patients treated with bedrest during the years 1963 to 19701 or with drug-induced hypotension (1970 to 1972).2 The use of historic