Tranexamic Acid in Symptomatic Chronic Subdural Hematoma in the Absence of Surgical Intervention

Background: Standard treatment for symptomatic chronic subdural hematoma (CSDH) is a burr-hole evacuation. However, in patients in whom surgical evacuation carries a very high risk, we do not have an established practice guideline.

Objective: To analyze the outcome of symptomatic CSDH treated only by tranexamic acid.

Material and methods: A total of 22 admitted patients with symptomatic chronic subdural hematoma from 2018 to 2019 were included in the study. All patients were managed conservatively with oral tablet tranexamic acid 250 mg thrice daily till the resolution of hematoma. Patients were followed up every month with CT scan brain. Data regarding the volume of hematoma, resolution of hematoma, and recurrence of hematoma were anonymized and analyzed.

Results: The median duration of treatment was 60 days (range 30-98). The median volume of hematoma before the initiation of the therapy was 74 ml (range 66-96), and it was reduced to 2 ml after the therapy with tranexamic acid. The median midline shift before the initiation of the therapy was 15 mm (range 10-20), and it was zero in all patients following the treatment. There was no progression or recurrence of hematoma in any one of patients. No major complications (thromboembolic events) due to the use of tranexamic acid were seen in any patient.

Conclusion: Even symptomatic patients with chronic subdural hematoma can be effectively managed with tranexamic acid when the surgical drainage is risky or not possible. It can be used as an alternative to surgery when there is no immediate threat to life.