Neurosurgical Center Amsterdam, Amsterdam UMC, Univ(ersity) of Amsterdam, Amsterdam, the Netherlands.
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, Zürich, Switzerland.
PLoS One. 2019 Feb 7;14(2):e0211868. doi: 10.1371/journal.pone.0211868. eCollection 2019.
Recurrent bleeding is one of the major causes of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Antifibrinolytic therapy is known to reduce recurrent bleeding, however, its beneficial effect on outcome remains unclear. The effect of treatment with tranexamic acid (TXA) until aneurysm treatment on clinical outcome is evaluated.
Patients with an aSAH from two high-volume tertiary referral treatment centers in the Netherlands, Academic Medical Center (AMC) and Radboud University Medical Center (RUMC), between January 2012 and December 2015 were included. Patients were classified into one of two groups; standard treatment or TXA treatment. Demographic and clinical characteristics, in-hospital complications and clinical outcome were compared between the two groups. Multivariate logistic regression was used to adjust for the influence of treatment center and baseline differences.
Standard treatment was given in 509 patients, and 119 patients received additional TXA therapy before aneurysm occlusion. Patients treated with TXA did not experience less recurrent bleeding adjusted or unadjusted for treatment center (adjusted odds ratio [aOR] 0.80, 95% confidence interval [95% CI]: 0.37-1.73). In-hospital mortality, was significantly lower in the TXA group than the standard care group (adjusted OR [aOR] 0.42, 95% CI: 0.20-0.85). Poor outcome (mRS 4-6) assessed after six months was not different between treatment groups (aOR 1.05, 95% CI: 0.64-1.74).
Pooled data from two high-volume treatment centers did not show improved clinical outcome after additional TXA treatment in aSAH patients. However, TXA treatment was associated with a decrease in mortality.
复发性出血是动脉瘤性蛛网膜下腔出血（aSAH）患者发病和死亡的主要原因之一。抗纤维蛋白溶解疗法已被证实可减少复发性出血，但对其治疗效果仍存在争议。本研究旨在评估氨甲环酸（TXA）治疗直至动脉瘤治疗对临床结局的影响。
该研究纳入了 2012 年 1 月至 2015 年 12 月期间在荷兰两家高容量三级转诊治疗中心（阿姆斯特丹学术医学中心[AMC]和拉德堡德大学医学中心[RUMC]）接受治疗的 aSAH 患者。患者分为标准治疗组或 TXA 治疗组。比较两组患者的人口统计学和临床特征、住院并发症和临床结局。采用多变量逻辑回归校正治疗中心和基线差异的影响。
标准治疗组有 509 例患者，119 例患者在接受动脉瘤闭塞治疗前接受了 TXA 治疗。调整治疗中心因素后，TXA 治疗组的复发性出血发生率并未降低（校正比值比[aOR]0.80，95%置信区间[95%CI]：0.37-1.73）。TXA 治疗组的住院死亡率显著低于标准治疗组（校正比值比[aOR]0.42，95%CI：0.20-0.85）。两组患者治疗 6 个月后的预后（mRS 4-6）评分无显著差异（校正比值比[aOR]1.05，95%CI：0.64-1.74）。
来自两家高容量治疗中心的汇总数据并未显示 aSAH 患者接受额外 TXA 治疗后临床结局得到改善。然而，TXA 治疗与死亡率降低相关。
