Influence of tranexamic acid on cerebral hemorrhage: A meta-analysis of randomized controlled trials

Abstract Tranexamic acid might be beneficial for cerebral hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on cerebral hemorrhage. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of tranexamic acid on cerebral hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model. Seven RCTs involving 1702 patients were included in the meta-analysis. Overall, compared with control intervention in cerebral hemorrhage, tranexamic acid could significantly reduce growth of hemorrhagic mass (RR = 0.78; 95% CI = 0.61–0.99; P = 0.04) and unfavorable outcome (RR = 0.75; 95% CI = 0.61–0.93; P = 0.008), but demonstrated no substantial influence on volume of hemorrhagic lesion (Std. MD = −0.10; 95% CI = −0.27 to 0.08; P = 0.28), neurologic deterioration (RR = 1.25; 95% CI = 0.60–2.60; P = 0.56), rebleeding (RR = 0.62; 95% CI = 0.35–1.09; P = 0.10), surgery requirement (RR = 0.78; 95% CI = 0.40–1.51; P = 0.46), and mortality (RR = 0.86; 95% CI = 0.69–1.05; P = 0.14). Compared to control intervention in cerebral hemorrhage, tranexamic acid was found to significantly decrease growth of hemorrhagic mass and unfavorable outcome, but showed no notable impact on volume of hemorrhagic lesion, neurologic deterioration, rebleeding, surgery requirement and mortality.