氨甲环酸对动脉瘤性蛛网膜下腔出血患者再出血、死亡率和脑积水的影响：系统回顾和荟萃分析。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-03-20 DOI:10.1016/j.jocn.2025.111189

Mohammed Maan Al-Salihi , Ahmed Abd Elazim , Maryam Sabah Al-Jebur , Ram Saha , Farhan Siddiq , Ali Ayyad , Adnan I. Qureshi

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Effect of tranexamic acid on rebleeding, mortality, and hydrocephalus in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis

Background

The therapeutic benefit of tranexamic acid (TXA) in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. We evaluated the efficacy and safety of TXA in aSAH patients by performing a comprehensive meta-analysis of randomized controlled trials (RCTs).

Methods

We conducted a systematic review and meta-analysis of RCTs comparing TXA with either placebo or standard care in aSAH patients. A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus from inception to July 2024. Outcomes of interest included rebleeding, mortality, functional outcomes, and delayed cerebral ischemia (DCI). Subgroup analyses were performed based on publication date and TXA administration duration.

Results

Thirteen RCTs were included in our study. TXA significantly reduced rebleeding rates (relative risk [RR] 0.61; 95 % confidence interval [CI] 0.51–0.74, P < 0.00001) but did not affect mortality (RR 0.99; 95 % CI 0.86–1.13, P = 0.84) or good clinical outcomes (RR 0.98; 95 % CI 0.93–1.05, P = 0.63). TXA use was associated with increased occurrence of hydrocephalus (RR 1.12; 95 % CI 1.01–1.23, P = 0.03) but not DCI (RR 1.00; 95 % CI 0.84–1.20, P = 0.96). Subgroup analyses suggested greater rebleeding reduction with longer TXA administration (≥1 week) and in more recent studies (post-2000).

Conclusions

TXA reduces rebleeding in aSAH but does not improve survival or functional outcomes. Its routine use in aSAH is not supported by current evidence.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.