Antifibrinolytic Therapy-Reply

In Reply.—  We thank Dr Vermeulen and his associates for their comments. The effectiveness of antifibrinolytic therapy has not been unequivocally proved. The whole subject has been recently reviewed.¹ Much of the controversy about the value of antifibrinolytic therapy has resulted from problems in methods. None of the studies (including ours), whether showing a positive response or no benefit of therapy, has met the methodologic criteria set forth by Vermeulen and Muizelaar.²We concur with Dr Vermeulen and his colleagues that any new study on the effectiveness of any therapy in patients with aneurysmal subarachnoid hemorrhage must include analysis of the variables of interval between hemorrhage and treatment, initial clinical condition, and number of days at risk. We also suggest that any study of antifibrinolytic therapy must include the variables of dosage, route of administration, and the method in which the drug is discontinued, in analysis of results of treatment.