Tranexamic acid in spontaneous intracerebral hemorrhage: an updated systematic review and meta-analysis of randomized controlled trials

Tranexamic acid (TXA) is a well-established antifibrinolytic medication in the general population. However, its efficacy and safety for patients with spontaneous intracerebral hemorrhage (ICH) remain inconclusive. Consequently, we conducted a systematic review and meta-analysis to assess the effectiveness and safety of TXA for spontaneous ICH. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following established methodological standards. Our search encompassed eight electronic databases from inception to April 25, 2024. The primary outcome was a reduction in all-cause mortality. The secondary outcomes included improvements in functional independence, neurological impairment, activities of daily living, and reduction in hematoma expansion (HE). Fixed-effects or random-effects model were performed for pooled data where eligible. A total of 9 RCTs that initially enrolled 3,124 patients were included. There were no significant differences observed concerning all-cause mortality (RR, 1.03; 95% CI [0.89–1.18]), hematoma expansion (RR, 0.90; 95% CI [0.80–1.00]), improvement of functional independence (RR, 1.02; 95% CI [0.92–1.12], neurological impairment (MD, −0.88 [95% CI, −2.22–0.45]), or activities in daily living (MD, −0.83 [95% CI, −29.25–12.59]). The pooled data indicated that TXA for ICH was associated with a decrease in hematoma volume from baseline (MD, −1.74; 95% CI [−2.47 to −1.02]). No significant difference in adverse events was observed between the TXA group and the control group. In summary, TXA does not affect all-cause mortality, functional outcomes, or neurological impairment, nor does it reduce HE, despite reducing hematoma volulume. TXA use for ICH requires careful clinical consideration.