Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery

Abstract

Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution.Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA and antithrombotics (AT) groups, according to the medical history of cardiocerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated.Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p < 0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p < 0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery.However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p < 0.001). There was no TXA-related adverse event. 4 Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

Effect of Postoperative Tranexamic Acid on Recurrence Rate and Complications in Chronic Subdural Hematomas Patients: Preliminary Results of a Randomized Controlled Clinical Trial

“…Since then, other studies have pointed divergent results. Yang et al 15 presented animating results in their sample, while Yamada et al 25 carried out a randomized clinical trial with a treatment protocol similar to the one in this study and found no bene t from tranexamic acid in terms of recurrence avoidance 25 .…”

“…When patients have normal conscience status, no motor de cits, and/or controlled symptoms like seizures or headache some nonsurgical treatments are being tried. There have been growing reports on the use of statins (HMG-CoA reductase inhibitors) [21][22][23][24] , tranexamic acid [12][13][14][15]25 (antiplasminogen anti brinolytic), a platelet-activating factor receptor antagonist (etizolam) 26,27 , angiotensin-converting enzyme inhibitors 28-30 , corticosteroids [31][32][33][34][35] , goreisan 13,25,36,37 and antiangiogenic endovascular procedures like embolization of the distal middle meningeal artery (MMA) [38][39][40][41][42][43] . All medications used until now share a potential role on in ammatory processes underlying CSDH formation.…”

“…Trans-4-(aminomethyl)-cyclohexane-1-carboxylic acid, also known as tranexamic acid (TXA), induces anti-brinolysis, and it is believed that it may promote hemostasis in microbleeding 12 . There are reports reduction in recurrence rate with the use of TXA in the postoperative period [13][14][15] . We conducted a prospective, randomized, controlled study to determine whether the postoperative use of oral tranexamic acid reduces the risk of recurrence after CSDH treatment by burr-hole and to evaluate any associated complications.…”

Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial

“…There have been growing reports on the use of statins (HMG-CoA reductase inhibitors) [21][22][23][24], tranexamic acid [12][13][14][15]25] (antiplasminogen antifibrinolytic), a platelet-activating factor receptor antagonist (etizolam) [26,27], angiotensin-converting enzyme inhibitors [28][29][30], corticosteroids [31][32][33][34][35], goreisan [13,25,36,37], and antiangiogenic endovascular procedures like embolization of the distal middle meningeal artery (MMA) [38][39][40][41][42][43]. All medications used until now share a potential role on inflammatory processes underlying CSDH formation.…”

“…Trans-4-(aminomethyl)cyclohexane-1-carboxylic acid, also known as tranexamic acid (TXA), induces anti-fibrinolysis, and it is believed that it may promote hemostasis in microbleeding [12]. There are reports of reduction in recurrence rate with the use of TXA in the postoperative period [13][14][15]. We conducted a prospective, randomized, controlled study to determine whether the postoperative use of oral tranexamic acid reduces the risk of recurrence after CSDH treatment by burr-hole and to evaluate any associated complications.…”