Is It Safe to Use Tranexamic Acid for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

Area of Science:

• Neurosurgery
• Pharmacology
• Evidence-based Medicine

Background:

• Chronic subdural hematoma (CSDH) recurrence after burr hole craniotomy (BC) remains a clinical challenge.
• The efficacy and safety of tranexamic acid (TXA) as an adjuvant therapy for CSDH post-BC are not well-established.
• Existing data on TXA for CSDH prevention after surgical intervention is limited.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of tranexamic acid (TXA) in preventing CSDH recurrence after burr hole craniotomy (BC).
• To evaluate the impact of TXA on reoperation rates, thrombosis risk, and mortality in CSDH patients undergoing BC.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched databases up to January 2024 for randomized controlled trials and cohort studies on TXA for CSDH post-BC.
• Included ten studies with 14,836 patients; primary outcomes were CSDH recurrence and reoperation; secondary outcomes included thrombosis and mortality.

Main Results:

• TXA as adjuvant therapy significantly reduced the pooled hematoma recurrence rate to 0.05 (95% CI [0.03-0.08], p < 0.01) compared to surgery alone.
• TXA demonstrated a significant reduction in postoperative hematoma recurrence.
• TXA use was associated with reduced reoperation, thromboembolic complications, and mortality in elderly CSDH patients post-BC.

Conclusions:

• Tranexamic acid (TXA) is effective in reducing CSDH recurrence after burr hole craniotomy (BC).
• TXA serves as a safe and beneficial adjuvant treatment, lowering reoperation, thromboembolic events, and mortality.
• This evidence supports the use of TXA in elderly patients undergoing surgical treatment for CSDH.