Associated Outcomes of Tranexamic Acid Use in Non-surgical Chronic Subdural Hematomas
Keywords:neurosurgery, chronic subdural hematoma, tranexamic acid, outcomes, mortality rate
Tranexamic acid (TXA) is a compound used to treat many bleeding conditions by inhibiting plasmin activity via binding to plasminogen and reducing fibrinolysis and inflammation. The role of TXA in the non-surgical management of chronic subdural hematomas (cSDH) has been studied previously, but data has been controversial. Mixed reports show TXA can reduce hematoma volume or result in complete resolution, while others show no benefit in reducing cSDH recurrence. Therefore, examined the impact of TXA in patients with cSDH who do not undergo burrhole drainage or middle meningeal artery embolization, and determine whether outcomes are associated with other complications.
We performed a retrospective case-control analysis using a multi-institutional database (TriNetX). We reviewed non-acute subdural hematoma patients who did not undergo surgical treatment and were treated with or without TXA. The primary endpoint was mortality at 6 months. Secondary endpoints included ventilator dependence, seizure, venous thromboembolism, myocardial infarction (MI), cerebral infarction, and percutaneous endoscopic gastrostomy (PEG). Cohorts were propensity score-matched for confounding variables.
470 patients were identified from TXA (cohort 1) and non-TXA (cohort 2) populations. The mean age at cSDH was 57.5 vs. 59.3 years. Mortality was seen in 93 patients (19.79%) in cohort 1 vs 73 (15.53%) in cohort 2 (P=0.09), ventilator dependence was 4.26% vs 2.55% (P=0.15), PEG placement was 5.75% vs 2.13% (P=0.004), seizures were 14.04% vs 11.28%(P=0.20), and venous thromboembolism was 8.09% vs 3.83% (P=0.006). There were too few patients with stroke and myocardial infarction for meaningful analysis of those outcomes.
TXA use in non-acute subdural hematomas is associated with an increased incidence of venous thromboembolism and PEG tube placement. In addition, TXA use was not found to benefit mortality 6 months post-operatively. It was not significantly associated with ventilator dependence or the occurrence of seizures, stroke, or myocardial infarction. Further research is needed to determine if hematoma characteristics, such as volume, may be related to outcomes seen in this study.
Copyright (c) 2023 Andrea Lin, David Hallan, Elias Rizk
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