Predictors of Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage Treated with Rapid Administration of Antifibrinolytic Agents and Strict Conservative Management

Kim, Chang Hyeun; Lee, Sang Weon; Kim, Young Ha; Sung, Soon Ki; Son, Dong Wuk; Song, Geun Sung

Tranexamic acid is a synthetic derivation of the amino acid lysine. It serves as an antifibrinolytic by reversibly binding to 4 or 5 lysine receptor sites on plasminogen molecules. This binding completely blocks the interaction of plasminogen and plasmin with lysine residues on the surface of fibrin, thereby preventing proteolytic action of plasmin on fibrin and inhibiting fibrinolysis at the bleeding site. 10) With this mechanism, tranexamic acid has https://kjnt.org https://doi.org/10.13004/kjnt.2019.15.e23 been used for decades in multiple surgical disciplines for its ability to reduce intraoperative blood loss and the need for blood transfusions. 17) Evidence suggests that tranexamic acid may also reduce postoperative edema and ecchymosis. 21) Tranexamic acid also passes through the blood-brain barrier and may be effective in hemorrhage diseases, including intracranial hemorrhages. 29) In light of these concepts, some researchers have reported that tranexamic acid reduces rebleeding in aneurysmal subarachnoid hemorrhages (SAH); although it has been reported that thromboembolic events or delayed cerebral ischemia also increases. 8, 21) In addition, recent systemic reviews have reported that the use of tranexamic acid in patients with nontraumatic SAH reduces mortality; however, this finding was not statistically significant. 2) In another intracranial hemorrhage study, Sorimachi et al. 26) reported that the combination of rapid administration of tranexamic acid and strict BP control may prevent hematoma growth in patients with ICH. 22) To the best of our knowledge, there is no evidence to show the effect of tranexamic acid in ICH aside from this study. Recently, several well-designed clinical trials, including those evaluating TICH-2, have been planned and conducted, but they have not shown statistically satisfactory results including reduce hematoma expansion and clinical outcomes. 22,33) Therefore, our study investigated the effect of tranexamic acid on ICH in a way similar to Sorimachi's study. 27) Our results showed that there was no statistical significance in ICH patients with rapid administration of tranexamic acid and strict conservative management, but the rate of patients who experienced hematoma expansion was reduced (14.5% vs. 10.7%).