Tranexamic acid for subarachnoid hemorrhage: A systematic review and meta-analysis

Am J Emerg Med. 2021 Dec:50:748-752. doi: 10.1016/j.ajem.2021.09.047. Epub 2021 Sep 22.

Abstract

Background: The efficacy of tranexamic acid for subarachnoid hemorrhage remains controversial. Thus, we conduct this meta-analysis to explore the efficacy of tranexamic acid for subarachnoid hemorrhage.

Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of tranexamic acid on subarachnoid hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model.

Results: Five RCTs and 2359 patients were included in the meta-analysis. Overall, compared with control intervention for subarachnoid hemorrhage, tranexamic acid was associated with significantly reduced risk of rebleeding (Odd ratio [OR] =0.62; 95% confidence interval [CI] =0.41 to 0.93; P = 0.02), but had no influence on mortality (OR = 0.94; 95% CI = 0.75 to 1.18; P = 0.61), poor outcome (OR = 0.95; 95% CI = 0.61 to 1.48; P = 0.82), hydrocephalus (OR = 1.17; 95% CI = 0.94 to 1.46; P = 0.17) or delayed cerebral ischemia (OR = 1.26; 95% CI = 0.78 to 2.04; P = 0.34).

Conclusions: Tranexamic acid may be effective to reduce the risk of rebleeding in patients with subarachnoid hemorrhage.

Keywords: Meta-analysis; Rebleeding; Subarachnoid hemorrhage; Tranexamic acid.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Antifibrinolytic Agents / therapeutic use*
  • Humans
  • Recurrence
  • Secondary Prevention
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / drug therapy*
  • Subarachnoid Hemorrhage / mortality
  • Subarachnoid Hemorrhage / prevention & control
  • Tranexamic Acid / therapeutic use*
  • Treatment Outcome

Substances

  • Antifibrinolytic Agents
  • Tranexamic Acid