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

  • Hyun, Seung-Jae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hwang, Sung-Nam (Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Chung-Ang University School of Medicine) ;
  • Park, Seung-Won (Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Chung-Ang University School of Medicine) ;
  • Nam, Taek-Kyun (Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Chung-Ang University School of Medicine) ;
  • Lee, Young-Suk (Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Chung-Ang University School of Medicine)
  • Published : 2010.03.30

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.

Keywords

References

  1. Guglielmi G, Vinuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:1-7, 1991 https://doi.org/10.3171/jns.1991.75.1.0001
  2. Hillman J, Fridriksson S, Nilsson O, Yu Z, Saveland H, Jakobsson KE. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg 97:771-8, 2002 https://doi.org/10.3171/jns.2002.97.4.0771
  3. Iplikcioglu AC, Berkman MZ. The effect of short-term antifibrinolytic therapy on experimental vasospasm. Surgical Neurol 59:10-6, 2003 https://doi.org/10.1016/S0090-3019(02)00867-4
  4. Kim JM, Kang SD. Benefits of antifibrinolytic therapy before early aneurysm surgery. J Korean Neurosurg Soc 30:729-33, 2001
  5. Lee CY, Yim MB, Lee JC, Son EI, Kim DW, Kim IH. The effect of antifibrinolytic therapy in prevention of rebleeding before early aneurysm surgery. J Korean Neurosurg Soc 30:1065-71, 2001
  6. Leipzig TJ, Redelman K, Horner TG. Reducing the risk of rebleeding before early aneurysm surgery: a possible role for antifibrinolytic therapy. J Neurosurg 86:220-5, 1997 https://doi.org/10.3171/jns.1997.86.2.0220
  7. Lim YJ, Park MS, Kim TS, Kim GK, Rhee BA, Leem W. The effect of antifibrinolytic therapy during acute period following subarachnoid hemorrhage. J Korean Neurosurg Soc 20:54-68, 1991
  8. Pleym H, Stenseth R, Wahba A, Bjella L, Karevold A, Dale O. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery. Anesth Analg 96:923-8, 2003
  9. Roos Y. Antifibrinolytic treatment in subarachnoid hemorrhage: a randomized placebo-controlled trial. STAR study group. Neurology 54:77-82, 2000 https://doi.org/10.1212/WNL.54.1.77
  10. Roos Y, Rinkel G, Vermeulen M, Algra A, van Gijn J. Antifibrinolytic therapy for aneurysmal subarachnoid hemorrhage: a major update of a cochrane review. Stroke 34:2308-9, 2003 https://doi.org/10.1161/01.STR.0000089030.04120.0E
  11. Roos Y, Beenen LFM, Groen RJM, Albrecht KW, Vermeulen M. Timing of surgery in patients with aneurysmal subarachnoid haemorrhage: rebleeding is still the major cause of poor outcome in neurosurgical units that aim at early surgery. J Neurol Neurosurg Psychiatry 63:490-3, 1997 https://doi.org/10.1136/jnnp.63.4.490
  12. Tanno Y, Homma M, Oinuma M, Kodama N, Ymamoto T. Rebleeding from ruptured intracranial aneurysms in North Eastern Province of Japan. A cooperative study. J Neurol Sci 258:11-6, 2007 https://doi.org/10.1016/j.jns.2007.01.074
  13. Tsementzis SA, Hitchcock ER, Meyer CHA. Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms. Acta Neurochirurgica 102:1-10, 1990 https://doi.org/10.1007/BF01402177