Korean J Neurotrauma.  2019 Oct;15(2):126-134. 10.13004/kjnt.2019.15.e23.

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

• Kim CH
• Lee SW
• Kim YH
• Sung SK
• Son DW
• Song GS

• KMID: 2461117
• DOI: http://doi.org/10.13004/kjnt.2019.15.e23

Abstract

OBJECTIVE
Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small blood vessels and other health problems. In ICH patients, hematoma enlargement is the most critical risk factor for poor outcomes. Tranexamic acid, an anti-fibrinolytic agent, has been used to reduce hematoma expansion. We analyzed the risk factors for hematoma expansion in ICH patients and compared the predictability of hematoma expansion in ICH patients with the use of tranexamic acid.
METHODS
We performed retrospective analysis of ICH patients who underwent follow-up computed tomography scans from October 2008 to October 2018. Of the 329 included patients, 67 who received tranexamic acid and 262 who did not receive tranexamic acid were compared. We also analyzed the risk factors of 45 and 284 patients who did and did not experience hematoma expansion, respectively.
RESULTS
Hematoma expansion was observed in 7 (10.4%) of 67 patients in the tranexamic acid group and 38 (14.5%) of the 262 patients who did not receive tranexamic acid. There was no statistically significant difference between patients who did and did not received tranexamic acid (p=0.389). In the multivariate logistic regression analysis of risk factors for hematoma expansion, spot sign and a maximal diameter of 40 mm were identified as risk factors.
CONCLUSION
We could not confirm the effect of tranexamic acid on hematoma expansion in ICH patients. Spot sign and the maximal diameter of hematomas were confirmed as risk factors of hematoma expansion. If the maximal diameter is greater than 40 mm, the hematoma should be closely monitored.

Keyword

Intracerebral hemorrhage; Tranexamic acid; Hematoma expansion; Risk factor

MeSH Terms

Antifibrinolytic Agents*
Blood Vessels
Cerebral Hemorrhage*
Follow-Up Studies
Hematoma*
Humans
Logistic Models
Retrospective Studies
Risk Factors
Rupture
Tranexamic Acid
Antifibrinolytic Agents
Tranexamic Acid

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