Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-07-24 DOI:10.1016/j.clineuro.2025.109071

Hamza Adel Salim , Nadeem Khayat , Huanwen Chen , Aneri B. Balar , Marco Colasurdo , Nimer Adeeb , Basel Musmar , Muhammed Amir Essibayi , Ahmed Msherghi , Sanjay Bhatia , Adam A. Dmytriw , Tobias D. Faizy , Max Wintermark , Vivek Yedavalli , Ajay Malhotra , Dheeraj Gandhi , Dhairya A. Lakhani

{"title":"Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis","authors":"Hamza Adel Salim , Nadeem Khayat , Huanwen Chen , Aneri B. Balar , Marco Colasurdo , Nimer Adeeb , Basel Musmar , Muhammed Amir Essibayi , Ahmed Msherghi , Sanjay Bhatia , Adam A. Dmytriw , Tobias D. Faizy , Max Wintermark , Vivek Yedavalli , Ajay Malhotra , Dheeraj Gandhi , Dhairya A. Lakhani","doi":"10.1016/j.clineuro.2025.109071","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Chronic subdural hematoma (CSDH) is frequently managed with surgical evacuation, but recurrence often necessitates repeat surgery. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as an adjunct to reduce rebleeding and recurrence. Data on its benefits and risks remain limited.</div></div><div><h3>Methods</h3><div>Using a federated electronic health record network (TriNetX), we identified adults (≥18 years) with CSDH who underwent surgical evacuation. Patients who received TXA within 14 days of CSDH (TXA group) were compared with those managed without TXA (surgery-alone group). Outcomes were assessed at 6-months. Propensity score matching (1:1) was performed.</div></div><div><h3>Results</h3><div>Of 15,423 eligible patients, 541 received TXA and 14,882 underwent surgery alone. After matching, 442 patients remained in each group. TXA was associated with a similar rate of needing repeat surgery (8.4 % vs. 9.5 %; OR, 0.870; 95 % CI, 0.548–1.382; P = 0.556). Secondary analysis showed significantly higher mortality rates in the TXA group (29.2 % vs. 14.0 %; OR, 2.526; 95 % CI, 1.802–3.541; P < 0.001), and a non-significant trend toward more thromboembolic events, including pulmonary embolism and deep vein thrombosis (9.3 % vs. 6.8 %; OR, 1.404; 95 % CI, 0.860–2.293; P = 0.173).</div></div><div><h3>Conclusions</h3><div>TXA as an adjunct to surgical evacuation of cSDH was not associated with different rates of disease recurrence requiring repeat surgery. Analyses of secondary outcomes showed that TXA was associated with numerically higher rates of DVT/PE and significantly higher mortality.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109071"},"PeriodicalIF":1.6000,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0303846725003543","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Chronic subdural hematoma (CSDH) is frequently managed with surgical evacuation, but recurrence often necessitates repeat surgery. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as an adjunct to reduce rebleeding and recurrence. Data on its benefits and risks remain limited.

Methods

Using a federated electronic health record network (TriNetX), we identified adults (≥18 years) with CSDH who underwent surgical evacuation. Patients who received TXA within 14 days of CSDH (TXA group) were compared with those managed without TXA (surgery-alone group). Outcomes were assessed at 6-months. Propensity score matching (1:1) was performed.

Results

Of 15,423 eligible patients, 541 received TXA and 14,882 underwent surgery alone. After matching, 442 patients remained in each group. TXA was associated with a similar rate of needing repeat surgery (8.4 % vs. 9.5 %; OR, 0.870; 95 % CI, 0.548–1.382; P = 0.556). Secondary analysis showed significantly higher mortality rates in the TXA group (29.2 % vs. 14.0 %; OR, 2.526; 95 % CI, 1.802–3.541; P < 0.001), and a non-significant trend toward more thromboembolic events, including pulmonary embolism and deep vein thrombosis (9.3 % vs. 6.8 %; OR, 1.404; 95 % CI, 0.860–2.293; P = 0.173).

Conclusions

TXA as an adjunct to surgical evacuation of cSDH was not associated with different rates of disease recurrence requiring repeat surgery. Analyses of secondary outcomes showed that TXA was associated with numerically higher rates of DVT/PE and significantly higher mortality.

查看原文本刊更多论文

氨甲环酸联合手术与单独手术治疗慢性硬膜下血肿：倾向评分匹配分析

背景：慢性硬膜下血肿（CSDH）通常采用手术引流治疗，但复发往往需要重复手术。氨甲环酸（TXA），一种抗纤溶药物，已被提议作为辅助，以减少再出血和复发。关于其益处和风险的数据仍然有限。方法使用联邦电子健康记录网络（TriNetX），我们确定了接受手术撤离的CSDH成人（≥18岁）。在CSDH后14天内接受TXA治疗的患者（TXA组）与不接受TXA治疗的患者（单独手术组）进行比较。6个月时评估结果。进行倾向评分匹配（1:1）。结果在15423例符合条件的患者中，541例接受了TXA治疗，14882例单独接受了手术。配对后，每组保留442例患者。TXA与需要重复手术的相似比率相关(8.4 % vs. 9.5 %；或者,0.870;95 % ci, 0.548-1.382； = 0.556页)。二次分析显示，TXA组的死亡率明显更高(29.2 % vs. 14.0 %；或者,2.526;95 % ci, 1.802-3.541；P <； 0.001)，以及更多血栓栓塞事件的非显著趋势，包括肺栓塞和深静脉血栓形成(9.3% % vs. 6.8% %；或者,1.404;95 % ci, 0.860-2.293； = 0.173页)。结论stxa作为cSDH手术清除的辅助手段与需要重复手术的疾病复发率无关。次要结果分析显示，TXA与数字上较高的DVT/PE发生率和显著较高的死亡率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.