Effectiveness Comparisons of Drug Therapy on Chronic Subdural Hematoma Recurrence: A Bayesian Network Meta-Analysis and Systematic Review

Yu, Wanli; Chen, Weifu; Jiang, Yongxiang; Ma, Mincai; Zhang, Wei; Zhang, Xiaolin; Yuan, Chao

doi:10.3389/fphar.2022.845386

Cited by 19 publications

(20 citation statements)

References 60 publications

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“…TXA can prevent fibrinolysis by blocking the lysine-binding site of plasminogen bound to fibrin and displacing plasminogen from the surface of fibrin ( Tanaka et al, 2001 ). Currently, TXA has been widely used in surgical procedures such as cardiothoracic surgery, neurosurgery, and obstetrics ( Yu et al, 2022 ). In the field of orthopedics, TXA exhibit a high effectiveness in reducing perioperative blood loss in spinal fusion surgery and joint replacement surgery ( Ling et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

Jiang

Xing²,

Zhe³

et al. 2022

Front. Pharmacol.

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Background: Tranexamic acid (TXA) has been widely applied to reduce perioperative bleeding. Recently, several studies focused on the administration of TXA in the treatment for with intertrochanteric fracture patients treated with intramedullary fixation. However, the efficacy and safety of TXA in these studies remain controversial. Therefore, we performed this systematic review and meta-analysis to investigate the efficacy and safety of TXA in intertrochanteric fracture patients treated with intramedullary fixation.Methods: We systematically searched electronic databases, including Cochrane, PubMed, and EMBASE, up to 16 May 2022. The efficacy and safety of TXA was evaluated in four aspects, which were bleeding-related outcomes, non-bleeding-related outcomes, thromboembolic events, and other complications. The outcomes of these studies were extracted and analyzed by RevMan Manager 5.4.Results: Finally, nine randomized controlled trials, involving nine hundred and seventy-two intertrochanteric fracture patients treated with TXA, were enrolled in this study. In the bleeding-related outcomes, TXA group was significantly lower than the control group in terms of total blood loss (MD = −219.42; 95% CI, −299.80 to −139.03; p < 0.001), intraoperative blood loss (MD = −36.81; 95% CI, −54.21 to −19.41; p < 0.001), hidden blood loss (MD = −189.23; 95% CI, −274.92 to −103.54; p < 0.001), and transfusion rate (RR = 0.64; 95% CI, 0.49 to 0.85; p = 0.002). Moreover, the postoperative hemoglobin on day 3 of the TXA group was significantly higher than that of the control group (MD = 5.75; 95% CI, 1.26 to 10.23; p = 0.01). In the non-bleeding-related outcomes, the length of hospital stays was significantly shorter in the TXA group (MD = −0.67; 95% CI, −1.12 to −0.23; p = 0.003). In terms of thromboembolic events, there was no significant differences between the TXA group and control group in deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke. As for complications and mortality, there was no significant differences between the TXA group and control group in respiratory infection, renal failure, and postoperative mortality within 1 year.Conclusion: TXA is an effective and safe drug for perioperative bleeding control in intertrochanteric fracture patients treated with intramedullary fixation. However, the long-term efficacy of TXA still needs to be investigated by large-scale multicenter randomized controlled trials.Level of evidence: II, Systematic review and Meta-analysis.Systematic Review Registration:https://inplasy.com/, identifier [INPLASY202280027]

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

Jiang

Xing²,

Zhe³

et al. 2022

Front. Pharmacol.

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“…The use of Dexamethasone, atorvastatin and tranexamic acid is examined in a number of trials. Recently, Yu et al. (2022) published his results of a Bayesian Network Meta-Analysis pointing out the improved recurrence rates following the use of the previous drug agents.…”

Section: Discussionmentioning

confidence: 99%

Valve-controlled chronic subdural hematoma drainage: A feasibility study

et al. 2022

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“…[11] From this context of CSDH pathogenesis, several medications have been used as preventive medicine for CSDH recurrence. Atorvastatin, dexamethasone, and tranexamic acid [21] were used. CSDH recurs from the theories of inflammation, angiogenesis, exudates, recurrent microbleeds, and local coagulopathy, which are shown by pathologically [6,14] and basically.…”

Section: Medication For Csdhmentioning

confidence: 99%

Japanese herbal Kampo medicine, Keishibukuryogan, for chronic subdural hematoma – Prospective observational study

Katsuki¹,

Kawamura²,

Koh³

2022

Surgical Neurology International

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Background: Pharmacological treatment for chronic subdural hematoma (CSDH) recurrence prevention after surgery is under debate. CSDH may be related to suidoku (fluid disturbance) from the Japanese herbal kampo perspective. Goreisan (GRS) treats suidoku and is used to prevent a postoperative recurrence. However, not all CSDHs are liquid, and some have structures such as trabecula, hematoma, and clots, suggesting oketsu (blood stasis). Therefore, we prospectively investigated the keishibukuryogan (KBG) effectiveness, which treats oketsu, for CSDH recurrence prevention and hematoma resolution compared to GRS. Methods: We prospectively prescribed KBG 7.5 g/day for 12 CSDH patients after burr-hole surgery. As a control cohort, we retrospectively collected 48 patients treated by GRS 7.5 g/day. The recurrence within 1 month and the hematoma thickness after 1 month were evaluated. Results: The median age was 84 years old. All the patients’ symptoms improved after surgery. The median preoperative midline shift and mean hematoma thicknesses were 6.0 mm and 23.75 mm. Those at 1 month were 2.0 mm and 11.43 mm. The recurrence rate was not significantly different between the KBG cohort (1 of 12) and the GRS cohort (4 of 48) (P = 0.999). The KBG’s noninferiority to GRS regarding the hematoma thickness at 1 month was statistically proven; KBG (12.26 mm) and GRS (11.20 mm). Conclusion: The recurrence rate at 1 month was not different between the KBG and GRS cohorts. The hematoma thickness at 1 month in the KBG cohort was not statistically inferior to that in the GRS cohort.

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Effectiveness Comparisons of Drug Therapy on Chronic Subdural Hematoma Recurrence: A Bayesian Network Meta-Analysis and Systematic Review

Cited by 19 publications

References 60 publications

Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

Valve-controlled chronic subdural hematoma drainage: A feasibility study

Japanese herbal Kampo medicine, Keishibukuryogan, for chronic subdural hematoma – Prospective observational study

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