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Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis

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A Correction to this article was published on 11 October 2023

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Abstract

Background

Rebleeding from a ruptured aneurysm increases the risk of unfavorable outcomes after subarachnoid hemorrhage (SAH) and is prevented by early aneurysm occlusion. The role of antifibrinolytics before aneurysm obliteration remains controversial. We investigated the effects of tranexamic acid on long-term functional outcomes of patients with aneurysmal SAH (aSAH).

Methods

This was a single-center, prospective, observational study conducted in a high-volume tertiary hospital in a middle-income country from December 2016 to February 2020. We included all consecutive patients with aSAH who either received or did not receive tranexamic acid (TXA) treatment. Multivariate logistic regression analysis using propensity score was used to evaluate the association of TXA use with long-term functional outcomes, measured by the modified Rankin Scale (mRS) at 6 months.

Results

A total of 230 patients with aSAH were analyzed. The median (interquartile range) age was 55 (46–63) years, 72% were women, 75% presented with good clinical grade (World Federation of Neurological Surgeons grade 1–3), and 83% had a Fisher scale of 3 or 4. Around 80% of patients were admitted up to 72 h from ictus. The aneurysm occlusion method was surgical clipping in 80% of the patients. A total of 129 patients (56%) received TXA. In multivariable logistic regression using inverse probability treatment weighting, the long-term rate of unfavorable outcomes (modified Rankin scale 4–6) was the same in the TXA and non-TXA groups (61 [48%] in TXA group vs. 33 [33%] in non-TXA group; odds ratio [OR] 1.39, 95% confidence interval [CI] 0.67–2.92; p = 0.377). The TXA group had higher in-hospital mortality (33 vs. 11% in non-TXA group; OR 4.13, 95% CI 1.55–12.53, p = 0.007). There were no differences between the groups concerning intensive care unit length of stay (16 ± 11.22 days in TXA group vs. 14 ± 9.24 days in non-TXA group; p = 0.2) or hospital (23 ± 13.35 days in TXA group vs. 22 ± 13.36 days in non-TXA group; p = 0.9). There was no difference in the rates of rebleeding (7.8% in TXA group vs. 8.9% in non-TXA group; p = 0.31) or delayed cerebral ischemia (27% in TXA group vs. 19% in non-TXA group; p = 0.14). For the propensity-matched analysis, 128 individuals were selected (64 in TXA group and 64 in non-TXA group), and the rates of unfavorable outcomes at 6 months were also similar between groups (45% in TXA group and 36% in non-TXA group; OR 1.22, 95% CI 0.51–2.89; p = 0.655).

Conclusions

Our findings in a cohort with delayed aneurysm treatment reinforce previous data that TXA use before aneurysm occlusion does not improve functional outcomes in aSAH.

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Funding

The authors declare no funding was received.

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Authors and Affiliations

  1. Intensive Care Unit, Cristo Redentor Hospital, Porto Alegre, Brazil

    Carla B. Rynkowski & Frederico Klein Gomes

  2. Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil

    Carla B. Rynkowski

  3. Pharmacy Department, Cristo Redentor Hospital, Porto Alegre, Brazil

    Vanessa Hegele & Monica Lopes Tonello

  4. Intensive Care Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil

    Pedro Henrique Rigotti Soares

  5. Lutheran University of Brazil, Canoas, Brazil

    Letícia Petterson

  6. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Alejandro A. Rabinstein

  7. Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil

    Leonardo S. L. Bastos

  8. Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Ricardo Turon, Bruno Gonçalves, Cassia Righy & Pedro Kurtz

  9. National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil

    Cassia Righy & Fernando A. Bozza

  10. D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil

    Fernando A. Bozza & Pedro Kurtz

  11. Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil

    Pedro Kurtz

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  1. Carla B. Rynkowski
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Contributions

CBR, VH, PHRS, MLT, LP, FKG, RT, BG, CR, and PK participated in data collection and adjudication of clinical data. CBR, AAR, RT, BG, CR, FAB, and PK contributed to the study conception and design, and data interpretation. CBR, BG, LSLB, and PK performed data processing, statistical analysis, and statistical revision. CBR, AAR, BG, and PK drafted the first version of the article. CBR, BG, CR, FAB, and PK supervised the study. All authors had full access to data, participated in data interpretation, revised the article, and approved the final version of the manuscript.

Corresponding author

Correspondence to Pedro Kurtz.

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We confirm adherence to ethical guidelines and indicate ethical approvals in the text. Research Ethics Committee (CAAE: 27362719.6.0000.5530).

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The original article has been updated to correct the name of coauthor from Leticia Peterson to Letícia Petterson.

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Rynkowski, C.B., Hegele, V., Soares, P.H.R. et al. Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis. Neurocrit Care 39, 191–197 (2023). https://doi.org/10.1007/s12028-023-01732-2

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