An open label randomized trial to assess the efficacy of tranexamic acid in reducing post-operative recurrence of chronic subdural haemorrhage

Wan, Kong-Wah; Qiu, Liming; Saffari, Seyed Ehsan; Khong, Wendy Xiao Ling; Ong, Jasmine Chiat Ling; See, Anna; Ng, Wai Hoe; King, Nicolas Kon Kam

doi:10.1016/j.jocn.2020.10.053

Cited by 20 publications

(22 citation statements)

References 41 publications

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“…The database search yielded 873 articles. Finally, 12 controlled trials were deemed eligible for inclusion in the Bayesian meta-analysis (Poulsen et al, 2014 ; Chan et al, 2015 ; Prud'homme et al, 2016 ; Jiang et al, 2018 ; Katayama et al, 2018 ; Workewych et al, 2018 ; Hutchinson et al, 2020 ; Mebberson et al, 2020 ; Wan et al, 2020 ; Yamada and Natori, 2020 ; Yang et al, 2020 ; Fujisawa et al, 2021 ). The PRISMA flow chart showing the publication selection process and a list of studies with reasons for exclusion are provided in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The eligible trials were published from 2014 to 2021, with population sizes ranging from 20 to 748 participants. One trial assessed perindopril (Poulsen et al, 2014 ); two trial assessed atorvastatin (Jiang et al, 2018 ; Yang et al, 2020 ); two trials assessed goreisan (Katayama et al, 2018 ; Fujisawa et al, 2021 ); three trials assessed tranexamic acid (Workewych et al, 2018 ; Wan et al, 2020 ; Yamada and Natori, 2020 ); and four trials assessed dexamethasone (Chan et al, 2015 ; Prud'homme et al, 2016 ; Hutchinson et al, 2020 ; Mebberson et al, 2020 ). One of the included randomized clinical trials (RCTs) was a three-arm trial (Yamada and Natori, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological Treatment in the Management of Chronic Subdural Hematoma

Wang

Song

et al. 2021

Front. Aging Neurosci.

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Background: Several pharmacological treatments have been used to treat patients with chronic subdural hematoma (CSDH), although little is known about the comparative effectiveness of different classes of medication. We performed a Bayesian network meta-analysis to compare and rank the efficacy and safety of five drug regimens to determine the best treatment for this group of patients.Methods: We systematically searched PubMed, Medline, clinicaltrials.gov, the Cochrane database, and Embase to identify relevant randomized clinical trials (RCTs) comparing drug treatments in adult patients with CSDH. A network meta-analysis was conducted using a Bayesian framework. Random- and fixed-effects models were used to pool the network results, and the preferred model was selected by comparing the deviance information criteria (DIC). Efficacy outcomes included recurrence requiring surgery, changes in hematoma volume, and a good recovery. The safety outcomes were treatment-related adverse events and all-cause mortality.Results: In this Bayesian network meta-analysis, available data were obtained from 12 eligible trials, including 2,098 patients and 5 techniques. Compared to placebo, atorvastatin (RR: 0.45, 95% CrI: 0.24–0.81) and dexamethasone (RR: 0.38, 95% CrI: 0.22–0.63) were similarly effective in reducing recurrence requiring surgery by 55% and 62%, respectively. Dexamethasone (RR: 0.46, 95% CrI: 0.23–0.91) was more effective in reducing recurrence requiring surgery than goreisan. Additionally, atorvastatin reduced the hematoma volume to a greater extent than placebo (MD: −7.44, 95% CrI: −9.49 to −5.43) or goreisan (MD: −14.09, 95% CrI: −23.35 to −4.82). Moreover, tranexamic acid (MD: −12.07, 95% CrI: −21.68 to −2.29) reduced the hematoma volume to a greater extent than goreisan. No significant differences were detected between drugs and placebo with regard to a good recovery. In terms of safety, dexamethasone (RR: 1.96, 95% CrI: 1.20–3.28) increased the risk of mortality compared to placebo.Conclusion: These findings suggest that dexamethasone is the best treatment to reduce recurrence and atorvastatin is the best treatment to reduce hematoma volume in patients with CSDH. However, clinicians should pay close attention to the elevated risk of all-cause mortality and potential adverse events caused by dexamethasone. Future well-designed RCTs with more participants are needed to verify these findings.Clinical Trial Registration:http://osf.io/u9hqp.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pharmacological Treatment in the Management of Chronic Subdural Hematoma

Wang

Song

et al. 2021

Front. Aging Neurosci.

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“…Instead, assessing platelet function and a short delay of the surgical intervention under clinical observation or hemostatic treatment with, e.g., desmopressin or tranexamic acid in more urgent cases seem to be sufficiently effective management strategies. Of note, the addition of tranexamic acid to standard surgical cSDH drainage has been associated with a delay of hematoma recurrence and a reduction of residual hematoma volume in a recent prospective randomized trial, indicating that it might be the preferrable choice when hemostatic management of cSDH patients on antiplatelets is required [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

et al. 2021

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In an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

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“…Tranexamic Acid in Chronic Subdural Hemorrhage Recurrence 12 Chronic subdural hemorrhage (CSDH) is a common condition encountered in neurosurgical practice around the world. Symptomatic patients undergo hematoma evacuation and up to 38.7% of patients may require repeat surgery for recurrence.…”

Section: Second-line Antiepileptic Drugs In Status Epilepticus 11mentioning

confidence: 99%

“…This study evaluated the role of tranexamic acid (TXA) in reducing postoperative recurrence of CSDH. 12 Patients were randomized into two groups-standard neurosurgical treatment only (observation arm) and standard neurosurgical treatment with TXA (TXA arm). The patients in TXA arm received 500 mg of TXA postoperatively twice daily for 21 days.…”

Section: Second-line Antiepileptic Drugs In Status Epilepticus 11mentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2020

Esmail

Subramaniam

Venkatraghavan

2021

Journal of Neuroanaesthesiology and Critical Care

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This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2020 (January–December 2020). The journals reviewed include anesthesia journals, critical care medicine journals, neurology and neurosurgical journals, as well as high-impact medical journals such as the Lancet, Journal of American Medical Association, New England Journal of Medicine, and Stroke. This summary of important articles will serve to update the knowledge of anesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical care patients. In addition, some of the important narrative reviews that are of interest to neuroanesthesiologists are also listed.

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An open label randomized trial to assess the efficacy of tranexamic acid in reducing post-operative recurrence of chronic subdural haemorrhage

Cited by 20 publications

References 41 publications

Pharmacological Treatment in the Management of Chronic Subdural Hematoma

Pharmacological Treatment in the Management of Chronic Subdural Hematoma

Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2020

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