Conservative Treatment of Chronic Subdural Hematoma in HIV-Associated Thrombocytopenia with Tranexamic Acid

Kutty, Raja K; Peethambaran, Anil Kumar; Sunilkumar,; Anilkumar, M. C.

doi:10.1177/2325957416680294

Cited by 13 publications

(9 citation statements)

References 16 publications

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“…Tanweer et al 5 described 14 patients with TXA after surgery for cSDH of whom none experienced a recurrence or complication. Kutty et al 6 and Moscote-Salazar 9 each described one patient with primary TXA treatment for cSDH and complete resolution of het cSDH. Mikkelsen et al 10 described one patient with five recurrences for which surgical intervention was performed.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The use of tranexamic acid (TXA), an antifibrinolytic agent, has been described in several reports, with quite positive results. [3][4][5][6][7][8][9][10] Recently, we started a double-blind, placebo-controlled, multicenter, randomized clinical trial in the Netherlands, the TORCHstudy (Tranexamic Acid to Prevent Operation in Chronic Subdural Hematoma), 11 to assess the efficacy of TXA to prevent surgery for patients diagnosed with cSDH for which a conservative treatment is selected as a primary treatment strategy. Here we describe the results of off-label TXA treatment in seven patients, in anticipation to this trial.…”

Section: Introductionmentioning

confidence: 99%

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Tranexamic acid for chronic subdural hematoma

Lodewijkx

Immenga

Berg

et al. 2021

British Journal of Neurosurgery

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Background: There is no consensus on optimal treatment for a chronic subdural hematoma (cSDH). In patients with only moderate symptoms treatment with tranexamic acid (TXA) has been suggested. We report off-label use of TXA in seven patients. Methods: Between August 2016 and May 2018 we identified seven patients for primary conservative treatment with TXA until satisfactory clinical and radiological status was achieved. Primary outcome was surgery for cSDH evacuation. Radiological follow-up was performed at regular intervals for hematoma volume measurements. Results: Five patients experienced complete resolution of symptoms, one patient had a burr-hole craniostomy five days after initiation of TXA treatment due to an increase of left-sided weakness and dysarthria and in one patient symptoms did not improve. Median follow-up was 15 weeks (range 6-25, without the operated patient). The median total volume before start of treatment was 83 mL (range 11-137) for all patients. At the last follow-up, the median total volume in the non-operated patients decreased by 73% to 33 mL (range 0-77). Conclusions: TXA could be considered as primary medical treatment in patients with a cSDH and mild symptoms. The results of current randomized clinical trials must be awaited.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tranexamic acid for chronic subdural hematoma

Lodewijkx

Immenga

Berg

et al. 2021

British Journal of Neurosurgery

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“…Antifibrinolytic drugs can stop bleeding by inhibiting plasminogen activation and plasminogen activity. Clinical case reports and retrospective studies have shown that tranexamic acid, as an antifibrinolytic drug, can be used to treat CSDH, promote hematoma absorption, and reduce recurrence [49][50][51][52][53]. However, some studies believed that antifibrinolytic drugs could increase the incidence of thrombotic events in patients [54].…”

Section: Hemostasis and Antifibrinolytic Therapy Of Chronic Subdural Hematomamentioning

confidence: 99%

Expert consensus on drug treatment of chronic subdural hematoma

Zhang

2021

Chin Neurosurg Jl

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Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33%). Because CSDH is often seen in the elderly, patients are weak and have many basic diseases. The risk of surgical treatment is high; serious complications and even death (the death rate is up to 32%) can often occur. The overall good prognosis rate of patients aged more than 90 years is 24%. The drug treatment can provide a safe and effective treatment for elderly patients who are weak, intolerable to surgery, or failed in surgery. Low-dose and long-term use of atorvastatin (20mg/d) is suggested for continuous treatment for at least 8 weeks, while low-dose and short-term use of dexamethasone can improve the therapeutic effect of atorvastatin on CSDH. Patients should undergo CT or MRI scanning at least one time within 2 weeks after the start of drug treatment.

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“…10) There were several other studies reporting the successful role of TXA as a primary treatment of CSDH or as a salvage medication at CSDH recurrence. 12,14,16,26) Recent studies have reported that TXA administration delayed the CSDH recurrence and reduced hematoma volume faster. 27,28) Although randomized trials are ongoing to reveal the efficacy of TXA, the role of TXA as an adjunctive medical treatment still lacks evidence.…”

Section: Introductionmentioning

confidence: 99%

Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery

Yang

Kim

Lee

et al. 2023

J Korean Neurosurg Soc

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Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution.Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA and antithrombotics (AT) groups, according to the medical history of cardiocerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated.Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p < 0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p < 0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery.However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p < 0.001). There was no TXA-related adverse event. 4 Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

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Conservative Treatment of Chronic Subdural Hematoma in HIV-Associated Thrombocytopenia with Tranexamic Acid

Cited by 13 publications

References 16 publications

Tranexamic acid for chronic subdural hematoma

Tranexamic acid for chronic subdural hematoma

Expert consensus on drug treatment of chronic subdural hematoma

Role of Adjunctive Tranexamic Acid in Facilitating Resolution of Chronic Subdural Hematoma after Surgery

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