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Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis
Hamza Adel Salim1, Nadeem Khayat2, Huanwen Chen3
1Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA; Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Clinical Neurology and Neurosurgery
|August 2, 2025
Summary
Tranexamic acid (TXA) did not reduce repeat surgery rates for chronic subdural hematoma. However, TXA use was linked to significantly higher mortality and a trend toward more thromboembolic events in patients undergoing surgical evacuation.
Area of Science:
- Neurosurgery
- Pharmacology
- Critical Care Medicine
Background:
- Chronic subdural hematoma (CSDH) often requires surgical evacuation, with recurrence posing a significant challenge.
- Tranexamic acid (TXA), an antifibrinolytic, is explored to mitigate rebleeding and recurrence after CSDH surgery.
- Limited data exists on the efficacy and safety of TXA in this context.
Purpose of the Study:
- To evaluate the effectiveness of tranexamic acid (TXA) as an adjunct therapy in reducing recurrence after surgical evacuation of chronic subdural hematoma (CSDH).
- To assess the safety profile of TXA, including rates of mortality and thromboembolic events, in patients with CSDH.
Main Methods:
- A retrospective cohort study utilizing the TriNetX federated electronic health record network.
- Adult patients (≥18 years) with CSDH undergoing surgical evacuation were identified.
- Propensity score matching (1:1) compared patients receiving TXA within 14 days of surgery versus those managed with surgery alone, with outcomes assessed at 6 months.
Main Results:
- Of 15,423 eligible patients, 442 were matched in both the TXA and surgery-alone groups.
- No significant difference in repeat surgery rates was observed between the TXA group (8.4%) and the surgery-alone group (9.5%; OR, 0.870; P=0.556).
- The TXA group exhibited significantly higher mortality (29.2% vs. 14.0%; OR, 2.526; P<0.001) and a non-significant trend towards increased thromboembolic events (9.3% vs. 6.8%; OR, 1.404; P=0.173).
Conclusions:
- Adjunctive TXA therapy in surgical evacuation of CSDH did not decrease the rate of disease recurrence requiring repeat surgery.
- TXA use was associated with numerically higher rates of deep vein thrombosis/pulmonary embolism and significantly increased mortality.
- The findings suggest caution regarding the use of TXA in CSDH patients due to potential safety concerns.
