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.