Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid

Intracranial bleeding in a haemodialysis patient is a serious, life threatening condition. Haemodialysis patients have a higher rate of spontaneous and traumatic subdural and/or intracerebral haematoma than the general population. This is, at least partially, attributed to impaired haemostasis, which is associated with end-stage renal disease and haemodialysis. The estimated incidence of subdural haematoma in chronic haemodialysis patients was 3.3%, with a high mortality rate reaching 85% [1]. There are no recent data available on the incidence of subdural and/or intracerebral haematoma in the haemodialysis population at large. The incidence is probably lower than 3.3% due to changing anticoagulation techniques involving the use of low-dose heparin rather than systemic heparinization, and the infrequency of the need for oral anticoagulation to maintain modern angioaccess patency [2]. However, a high mortality rate is still characteristic of haemodialysis patients suffering intracranial haemorrhage [3,4]. The recommended treatment of subdural/intracerebral haematoma is a combination of surgical drainage, if possible, and conservative supportive measures such as heparin-free dialysis, strict bed rest and anti-oedema treatment. However, the correction of impaired haemostasis is not a focus of current treatment. In this report, we describe an apparently successful management of intracranial bleeding in a haemodialysis patient using the antifibrinolytic agent tranexamic acid.