The Effect of Preoperative Short-term Use of Tranexamic Acid in Patients with Aneurysmal Subarachnoid Hemorrhage

Hyun, Seung Jae; Hwang, Sung Nam; Park, Seung Won; Nam, Taek Kyun; Lee, Young Suk

Abstract

OBJECTIVE
The goal of this study was to determine the effect of short-term usage of tranexamic acid (TXA), which is an antifibrinolytic agent, on patients with aneurysmal subarachnoid hemorrhage (aSAH).
METHODS
We prospectively analyzed 80 consecutive patients who had undergone surgery for aSAH between January 2004 and December 2006. The patients were placed either in the TXA group for those who were treated with TXA (N=38) or in the n-TXA group for those who were not (N=42). The incidences of rebleeding and vasospasm (with using the transcranial Doppler (TCD) criteria), symptomatic vasospasm and hydrocephalus were compared between the two groups.
RESULTS
Preoperative rebleeding occurred only in one patient in each group (2.6% of the TXA group and 2.3% of the n-TXA group (p>0.05). Vasospasm developed in 18 (47.4%) of the TXA patients and in 20 (47.6%) of the n-TXA patients (p>0.05). Among the patients with vasospasm, the number of symptomatic vasospasms was 16 (89%) in the TXA group and 11 (55%) in the n-TXA group (p<0.05). The patients with symptomatic vasospasm in the TXA group seemed to have worse outcomes than those in the n-TXA group (p>0.05). The incidence of hydrocephalus was not different between the two groups.
CONCLUSION
We conclude that the preoperative short-term use of TXA can increase the risk of postoperative symptomatic vasospasm, although the incidence of vasospasm was not different between the two groups. According to our results, we recommend being very cautious of vasospasm and ischemic events when TXA is used preoperatively in patients with aSAH.