TXA for SAH?

Tranexamic acid (TXA) is an antifibrinolytic drug that stabilizes clots and helps to control bleeding. It is often used in acute trauma and of cases of massive hemorrhage. It is not prothrombotic, so it can help to control bleeding while not increasing clotting like some other drugs. So, is there a place for it in the initial management of aneurysmal subarachnoid hemorrhage?

Endovascular coiling or surgical clipping is the preferred management of bleeding cerebral aneurysms, but could TXA be useful in situations where surgical management is not readily available? Pharmacy Joe looks at a new study by Long and Gottlieb in Academic Emergency Medicine that seeks to answer that question.

The review of the literature included 13 studies of nearly 3000 patients and essentially concluded that there was no real benefit. Although there was no difference in adverse events between placebo and TXA, there was no difference in mortality or functional outcomes either. There did appear to be a benefit when it came to rebleeding. The study found 8.7% reduction in rebleeding among patients treated with TXA. So, there may be some benefit in reducing further complications, but more study is needed.

Check out Pharmacy Joe’s episode for all the details and links to the relevant evidence.

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