Kutty Raja K, Leela Sureshkumar Kunjuni, Sreemathyamma Sunilkumar Balakrishnan, Sivanandapanicker Jyothish Laila, Asher Prasanth, Peethambaran Anilkumar, Prabhakar Rajmohan Bhanu
Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105273. doi: 10.1016/j.jstrokecerebrovasdis.2020.105273. Epub 2020 Sep 4.
The conservative management of Chronic subdural hematoma (CSDH) is controversial. Many drugs have been tried in the conservative management of CSDH. Tranexamic acid (Txa) is one such drug in the armamentarium for conservative management of CSDH. We conducted a prospective observational study about treatment of CSDH with Txa.
The study was conducted over three years. The clinical grading was assessed by the Markwalder grading system. All patients who were relatively and mildly symptomatic and willing for conservative management were recruited for the study. All patients were given Txa in the dosage of 750 mg/day in divided doses. The patients were followed up in the neurosurgery out-patient department.
There were 27 patients with 30 CSDH during this period who were treated with Txa. There were 20 cases of primary CSDHs and 7 cases of recurrent CSDHs following surgery that were enrolled in the Txa group. The mean volume of treated CSDH was 135.62 ± 92.90 SD. The mean thickness of CSDH enrolled in the study was 14.31 ± 5.47 SD. The mean number of days the patients treated with Txa was 64.83 ± 24.8 SD. There were no complications in any of the patients. All patients had good resolution of the hematomas, and none of the hematomas progressed during conservative treatment.
The conservative management of CSDH with Txa is both a safe and effective alternative in the absence of life-threatening symptoms.
慢性硬膜下血肿（CSDH）的保守治疗存在争议。许多药物已被尝试用于CSDH的保守治疗。氨甲环酸（Txa）是CSDH保守治疗药物库中的一种此类药物。我们进行了一项关于用Txa治疗CSDH的前瞻性观察研究。
该研究进行了三年。临床分级采用Markwalder分级系统评估。所有相对症状较轻且愿意接受保守治疗的患者被纳入研究。所有患者均给予Txa，剂量为750mg/天，分剂量服用。患者在神经外科门诊进行随访。
在此期间，有27例患者共30个CSDH接受了Txa治疗。Txa组纳入了20例原发性CSDH和7例手术后复发性CSDH。接受治疗的CSDH平均体积为135.62±92.90标准差。纳入研究的CSDH平均厚度为14.31±5.47标准差。接受Txa治疗的患者平均天数为64.83±24.8标准差。所有患者均无并发症。所有患者血肿均得到良好吸收，且在保守治疗期间无血肿进展。
在没有危及生命症状的情况下，用Txa对CSDH进行保守治疗是一种安全有效的替代方法。
