Efficacy and Safety of Tranexamic Acid in Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Muhammad Ansari1, Hassan Waseem2, Zain abideen3, Muhammad Fawad Tahir4, Rowaid Ahmad1, Sania Aimen5
1University of Texas Medical Branch Galveston Texas, United States, 2Allama Iqbal Medical College, Lahore, Pakistan, 3King Edward Medical University, Lahore, Pakistan, 4H.B.S Medical and Dental College, Islamabad, Pakistan, 5Quetta Institute of Medical Sciences, Pakistan
Objective:
This study aims to assess the efficacy and safety of Tranexamic acid (TXA) in acute spontaneous intracerebral hemorrhage (ICH).
Background:
Tranexamic acid (TXA), an antifibrinolytic agent, may help limit hematoma expansion in intracerebral hemorrhage (ICH), particularly in patients on non-vitamin K antagonist oral anticoagulants (NOACs). However, evidence-based treatment for NOAC-ICH is lacking, and the effectiveness of TXA in preventing hematoma growth remains uncertain. This study aims to assess the efficacy and safety of intravenous TXA in reducing hematoma expansion compared to placebo.
Design/Methods:
PubMed, Scopus, and Cochrane Library were searched till September 2024. Data were pooled as Risk ratios (RR) and Mean difference (MD) with a 95% Confidence Interval (CI) for the dichotomous and continuous outcomes respectively using the random effects model in the Review Manager version 5.4.1. The primary outcome was hematoma expansion, while secondary outcomes included 3-month poor functional outcomes (PFO), mortality, and major thromboembolic events (MTE). The quality of the included studies was evaluated using the Cochrane RoB 2.0 tool and publication bias through funnel plots. Sensitivity analysis was conducted for heterogeneity.
Results:
A total of seven randomized controlled trials involving 2,914 participants were included in the analysis. TXA showed a non-significant decrease in HE compared to the placebo, with an RR of 0.89 (95% CI: [0.79,1.01]; p = 0.06; I² = 0%). The two groups were comparable in terms of PFO (RR=1.00; 95% CI:[0.93,1.07]; p = 0.95; I² = 0%), 3-month mortality (RR=1.03; 95% CI:[0.90,1.19]; p = 0.67; I² = 0%), and MTE (RR=1.16; 95% CI:[0.79,1.70]; p = 0.45; I² = 0%).
Conclusions:
TXA showed a non-significant reduction in HE. Additionally, there were no significant differences in poor functional outcomes, mortality, or major thromboembolic events between the TXA and placebo groups. Further research is needed to confirm its potential benefits.
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