Introduction: Epsilon amino-caproic acid (EACA) and other antifibrinolytic agents are used to prevent rehemorrhage following aneurysmal subarachnoid hemorrhage (SAH). Increased rates of hydrocephalus (HCP) due to EACA administration has been reported. We present a case control study investigating the relationship between EACA administration and the development of shunt-dependent HCP.

Methods: A power analysis was performed to determine sample size. All of the patients in this study were managed by a single neurosurgeon who treated all SAH patients with EACA prior to February, 2012 and then discontinued the use of EACA after that time. From a cohort of 129 consecutive patients diagnosed with SAH who met inclusion criteria, 57 patients who required placement of a ventriculoperitoneal shunt (VPS) were identified as cases. The remaining 72 patients, who did not get a VPS, were designated as controls. Demographic data, clinical and radiographic grading scales and details of the clinical course and treatment were extracted from a retrospective review of medical charts of both groups. Cases and controls were compared to identify factors that contributed to the development of shunt-dependent HCP.

Results: The overall rate of VPS placement was 44%. The rate of EACA treatment was in the cases was 43.9%, and 55.6% among the controls (p=0.2). Patients presenting with intraventricular hemorrhage or with a Hunt and Hess III or IV clinical exam were more likely to require a VPS (p<0.0001).

Conclusions: The administration of EACA does not appear to increase the incidence of shunt-dependent HCP following SAH.

Patient Care: There has been a trend towards abandoning anti-fibrinolytic therapy in the treatment of SAH due to concern for increased rates of shunt-dependent hydrocephalus. There have been no studies dedicated to elucidating any causative relationship between these two entities. Our study shows that the administration of anti-fibrinolytic agents does not cause increased rates of hydrocephalus and anti-fibrinolytic agents should not be held for this concern.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the controversy surrounding anti-fibrinolytic agents in the treatment of SAH, 2) Describe clinical factors contributing to the development of shunt-dependent hydrocephalus following SAH.

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