Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Apr 18;46(1):90.
doi: 10.1007/s10143-023-01991-9.

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

Marcus Vinícius Carneiro Torres de Paula  1 , Bernardo Duarte Chamon Ribeiro  1 , Marina Mendes Melo  1 , Pedro Victor Vidal de Freitas  1 , Felix Hendrik Pahl  1 , Matheus Fernandes de Oliveira  2 , José Marcus Rotta  1
Affiliations
Randomized Controlled Trial

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

Marcus Vinícius Carneiro Torres de Paula et al. Neurosurg Rev. .

Abstract

Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. A prospective, randomized, and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Twenty-six patients were randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness, and drain use. Clinical and radiological recurrence occurred in three patients (6%), being two cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in two patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had two complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.

Keywords: Chronic subdural hematoma; Surgery; Tranexamic acid; Treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Hematoma thickness measurement. We used larger diameter in axial and coronal sections
Fig. 2
Fig. 2
Nakaguchi classification. [16] (adapted from: Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2001;95(2):256–262)
Fig. 3
Fig. 3
Flow chart of patient enrolment
Fig. 4
Fig. 4
CT images of 3 patients with recurrence. a, b = TXA group. c = control group
See this image and copyright information in PMC

Comment in

References

    1. Toi H, Kinoshita K, Hirai S, et al. Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database. J Neurosurg. 2018;128(1):222–228. doi: 10.3171/2016.9.JNS16623. - DOI - PubMed
    1. De Oliveira MF. Chronic subdural hematomas and pursuit of nonsurgical treatment alternatives. World Neurosurg. 2019;126:481–483. doi: 10.1016/j.wneu.2019.03.151. - DOI - PubMed
    1. Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014;121(3):665–673. doi: 10.3171/2014.5.JNS132715. - DOI - PubMed
    1. Guilfoyle MR, Hutchinson PJ, Santarius T. Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir (Wien) 2017;159(5):903–905. doi: 10.1007/s00701-017-3095-2. - DOI - PMC - PubMed
    1. Kolias AG, Chari A, Santarius T, et al. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014;10(10):570–578. doi: 10.1038/nrneurol.2014.163. - DOI - PubMed

Publication types

Substances

LinkOut - more resources