Antifibrinolytic Therapy of Chronic Subdural Hematomas

Summary

We treated 182 cases of chronic subdural hematoma (CSH) by burr hole evacuation with subsequent drainage since 1987. In these cases, 36 cases showed unchanged volume of CSHs or further enlargement after initial surgery. We repeated surgical therapy in 20 of these cases which were treated before 1989 (group I). Only a medical therapy with careful observation was employed in the remaining 16 cases treated after 1989 (group II). No significant difference was noted between these 2 groups. The medical therapy in the group II patients consisted of administrations of tranexamic acid (750mg/day, P.O.) and carbazochrome sodium sulfonate (30–60mg/day, P.O.). Tranexamic acid was not administered in the group I patients. CSHs eventually resolved in all of the group I patients after one or more surgical interventions. Complete hematoma resorbence with clinical restoration was, however, also obtained in all of the group II patients with medical therapy alone. No recurrence was observed during the follow-up period ranging from 1 month to 2 years. These results indicate that recurent CSHs can be successfully treated by antifibrinolytic therapy alone and hyperfibrinolysis within CSHs plays a significant role in the enlargement of CSHs.