Tranexamic acid for patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of 2991 patients

Medical Research Group of Egypt, Cairo, Egypt. Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Faculty of Medicine, South Valley University, Qena, Egypt. Faculty of Medicine, Zagazig University, Zagazig, Egypt. Resident Physician, Egyptian Fellowship of Neurology, Nasr City Hospital for Health Insurance, Cairo, Egypt. College of Medicine, University of Ibadan, Ibadan, Nigeria. Department of Neurosurgery, National Bank Hospital, Nasr City, Egypt. Faculty of Medicine, Al Azhar University, New Damietta, Egypt. Faculty of Medicine, Aleppo University, Syria. Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA. Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon. Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon. School of Pharmacy and Biomedical Sciences, University of Portsmouth, United Kingdom. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.

The International journal of neuroscience. 2022;:1-14
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OBJECTIVE We aimed to synthesize evidence from published clinical trials on the efficacy and safety of tranexamic acid (TXA) administration in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS We followed the standard methods of the Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until 1 January 2022. We selected observational studies and clinical trials comparing TXA versus no TXA in aSAH patients. Data of all outcomes were pooled as the risk ratio (RR) with the corresponding 95% confidence intervals in the meta-analysis models. RESULTS Thirteen studies with a total of 2991 patients were included in the analysis. TXA could significantly cut the risk of rebleeding (RR 0.56, 95% CI 0.44 to 0.72) and mortality from rebleeding (RR 0.60, 95% CI 0.39 to 0.92, p = 0.02). However, TXA did not significantly improve the overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus (all p > 0.05). In terms of safety, no significant adverse events were reported. No statistical heterogeneity or publication bias was found in all outcomes. CONCLUSION In patients with aSAH, TXA significantly reduces the incidence of rebleeding and mortality from rebleeding. However, current evidence does not support any benefits in overall mortality, neurological outcome, delayed cerebral ischemia, or hydrocephalus.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine