Tranexamic acid in spontaneous intracerebral hemorrhage: an updated systematic review and meta-analysis of randomized controlled trials

TL;DR

This study reviews whether tranexamic acid helps patients with brain bleeds, finding limited benefits despite some reduction in blood clot size.

Contribution

An updated systematic review and meta-analysis of RCTs on tranexamic acid for spontaneous intracerebral hemorrhage.

Findings

TXA does not significantly reduce all-cause mortality in ICH patients.

TXA is associated with a small reduction in hematoma volume from baseline.

No significant improvement in functional outcomes or neurological impairment was observed with TXA.

Abstract

Tranexamic acid (TXA) is a well-established antifibrinolytic medication in the general population. However, its efficacy and safety for patients with spontaneous intracerebral hemorrhage (ICH) remain inconclusive. Consequently, we conducted a systematic review and meta-analysis to assess the effectiveness and safety of TXA for spontaneous ICH.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following established methodological standards. Our search encompassed eight electronic databases from inception to April 25, 2024. The primary outcome was a reduction in all-cause mortality. The secondary outcomes included improvements in functional independence, neurological impairment, activities of daily living, and reduction in hematoma expansion (HE). Fixed-effects or random-effects model were performed for pooled data where eligible.

A total of 9 RCTs that initially enrolled 3,124 patients were included. There were no significant differences observed concerning all-cause mortality (RR, 1.03; 95% CI [0.89–1.18]), hematoma expansion (RR, 0.90; 95% CI [0.80–1.00]), improvement of functional independence (RR, 1.02; 95% CI [0.92–1.12], neurological impairment (MD, −0.88 [95% CI, −2.22–0.45]), or activities in daily living (MD, −0.83 [95% CI, −29.25–12.59]). The pooled data indicated that TXA for ICH was associated with a decrease in hematoma volume from baseline (MD, −1.74; 95% CI [−2.47 to −1.02]). No significant difference in adverse events was observed between the TXA group and the control group.

In summary, TXA does not affect all-cause mortality, functional outcomes, or neurological impairment, nor does it reduce HE, despite reducing hematoma volulume. TXA use for ICH requires careful clinical consideration.

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