Non Surgical Treatment Of Chronic Subdural Hematoma With Tranexamic Acid

Objective: To discuss the pathophysiology of CSDH and evaluate the effect of tranexamic acid(TXA)in medical treatment of Chronic subdural hematoma(CSDH).Methods: From Mar 2014 to Mar 2016,a total of 21 patients with CT-confirmed CSDH in our department under a human subject protocol approved by the Ethics Committee of the affiliated hospital of Southwest Medical University.Patients enrolled in the study were evaluated using Markwalder's Grading Scale(MGS)at admission and during a routine clinic visit.this study enrolled only patients with Grades 0–? CSDH.patients with the following conditions were excluded from the study: a high risk of cerebral hernia and/or the necessity of immediate surgical intervenetion;bleeding tendency defined as activated partial thromboplastin time > 40.0 s,prothrombin time>15s,thrombin time>25s,or INR>1.5.Patients who were taking warfarin were excluded from the study.The patients were received an intravenous dose of 1g TXA in the first week,and followed by a maintenance oral dose of 250 mg TXA three times a day for 1-5 months(2.8±1.0 months).These patients received a follow-up period of 6-10 months.Hematoma volume and neurological functions were compared before and after treatment?This clinical study also includes 86 adult patients with CSDH,who were treated with burr holes at the same period.In this study,the curative rati,Therapeutic Effects and Adverse Reactions,the mean hospital stay and associated costs were be analytical investigation.Results: The effect of tranexmamic acid was evaluated by changes in hematoma volume and clinical symptoms.The therapeutic outcome was divided into effectiveness and ineffectiveness.effectiveness : hematoma was no longer detected on CT scans and neurological symptoms were undetectable.one patient lost,fifteen cases(75%)were effective.six cases(25%)were ineffective.ineffectiveness : hematoma volume increased/unchanged(>1 month),aggravated neurological symptoms,or the side-effect of drug.Among them,three patients(15%)whose neurological functions deteriorated underwent surgery,one patient(5%)who did not show any improvement with initial one month of TXA underwent surgery,one patient(5%)stopped the treatment due to the side-effect of drug.In whole therapeutic process,average hematoma volume were decreasing gradually: 50.4±33.2ml?39.9±30.6ml(1moth)?6.20±9.24ml(3moth).Conclusion:Tranexamic acid is a specific antifibrinolytic drug that inhibits plasminogen activation and plasmin activity.It is a derivative of the amino acid lysine and exerts antifibrinolytic effects by reversibly binding to lysine sites on plasminogen.hyperfibrinolytic activity has been shown to be critical for liquefaction of the hematoma and progression of CSDH.the kallikrein system induces inflammation,vascular permeability increases.tranexamic acid might inhibit the hyperfibrinolytic activity and the increased vascular permeability.Results of this preliminary study show that the administration of tranexmamic acid is effective and safe in treating CSDH?This report shows that tranexmamic acid is easy ways to treatment for CSDH compared to a surgical intervention,especially for the patient who Refused to surgery or with operative contraindication.Considerable brain atrophy and advanced age predispose an unfavorable outcome,a priority treatment for CSDH is tranexmamic acid.