Introduction: Chronic subdural hematomas (SDH) are commonly encountered in neurosurgery. Optimal management of SDHs remains a significant challenge. Current treatment options generally include supportive care or surgical intervention. A significant proportion have surgery; however, the reoperation rate is considered high. Additionally, there are cases in which additional surgical procedures would carry significant morbidity, and as a result, there is a need for nonsurgical medical therapies. Herein, we describe the use of tranexamic acid (TXA) as a nonsurgical option for the treatment of recurrent SDHs following surgery.
Methods: Patients were identified as candidates for potential TXA therapy and followed prospectively. Decision to administer TXA were made on the basis of history, presentation, and prognosis after further surgical intervention. Data collected included patient imaging, treatment administered, and both radiological and clinical outcomes.
Results: Three patients underwent surgical evacuation of a chronic subdural hematoma (2 via burr hole washout, 1 via craniotomy). All patients had recurrence identified on subsequent imaging. Two patients had poorer predicted outcomes if additional surgical intervention was necessary, while for one, additional surgical intervention was refused. TXA was administered, in the same dosing and scheduled course, to all patients. Complete resolution was observed on imaging, and in the case of the patient who was symptomatic, clinical improvement was also noted.
Conclusions: TXA may be considered for treatment of recurrent subdural hematomas following surgical evacuation in patients for whom additional surgery would add significant morbidity.
Patient Care: In this abstract, we describe the use of TXA as a medical adjuvant therapy for the resolution of recurrent subdural hematomas following surgery. This is important in cases where additional surgical procedures carry significant morbidity and times when the patient or family refuses surgery. In our case series, we demonstrate the safe usage of this drug and present positive outcomes which include complete resolution of SDHs and clinical improvement in symptomatic patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the mechanism of TXA and its effect on SDHs; 2) Discuss how and to whom this treatment should be applied to; 3) Identify an effective treatment strategy for patients in which additional surgical procedures carry significant risks.