Introduction: Non-acute subdural hematomas (SDHs) are a cause of significant morbidity and mortality in our aging population. There are several options for treatment including observation, burr hole drainage at the bedside or in the operating room, and craniotomy. While there is no consensus concerning the best mode of treatment, there has been an increasing trend toward bedside procedures, especially for poor surgical candidates. Additionally, tranexamic acid (TXA), an antifibrinolytic agent, has been shown to resolve small chronic SDHs managed non-operatively. (4). The purpose of this study was to examine the role of TXA as an adjunct to bedside evacuation of mixed density SDHs.
Methods: A retrospective chart review was conducted at NYU and Bellevue Hospital between March 2013 and November 2015. Fifty-one patients were included who underwent placement of a bedside Subdural Evacuating Port System (SEPS). Twenty-nine patients were subsequently treated with oral TXA (650mg daily). All CT images were analyzed by a surgeon blinded to patient identifiers. SDH dimensions were measured from the CT scans, and volumes were calculated using the “modified a x b x c/2” method 5.
Results: Fifty one SDHs in 39 patients met the inclusion criteria. The majority of SDHs were mixed density. There was no statistically significant difference in gender, patient age, age of subdural, or history of coagulopathy between the two groups. The only statistically significant end point was percent difference in midline shift. No increase or recurrence of the SDH was noted during TXA treatment. Five(22.7%) patients in the non TXA group and 6(20.6%) patients in the SEPS followed by TXA group required further intervention. There were no thrombotic complications.
Conclusions: Oral TXA treatment does not increase complications and improves the percent change in midline shift in a statistically significant manner. Prospective studies are needed to further evaluate the role of TXA for adjunctive treatment of SDHs.
Patient Care: TXA provides a non invasive intervention with a low risk profile that could be used as an adjunct to a bedside procedure to expedite clinical recovery and radiologic improvement of large mixed density subdural hematomas that are sources of significant morbidity and mortality in the older population.
Learning Objectives: Evaluate the role and safety of TXA after bedside SEPS procedure in the management of large mixed density subdural hematomas
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