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Vol 6, No 4 (2021)
Research paper
Published online: 2021-11-03
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Place of tranexamic acid in traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Mahdi Al-Jeabory12, Lukasz Szarpak134, Zubaid Rafique5, Nilesh R. Vasan6, Kecskes Attila7, Aleksandra Gasecka89, Wladyslaw Gawel10, Michal Pruc1, Marek Malysz1, Milosz J. Jaguszewski11, Ivan Savytskyi12, Natasza Blek3, Krzysztof J. Filipiak3, Frank W. Peacock5
DOI: 10.5603/DEMJ.a2021.0029
·
Disaster Emerg Med J 2021;6(4):155-163.
Affiliations
  1. Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
  2. Research Unit, Polonia Academy, Czestochowa, Poland
  3. Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Poland
  4. Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
  5. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
  6. College of Medicine, The University of Oklahoma, United States
  7. NATO Centre of Excellence for Military Medicine, Budapest, Hungary
  8. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
  9. Department of Cardiology, University Medical Center Utrecht, CX Utrecht, The Netherlands
  10. Department of Surgery, The Silesian Hospital in Opava, Czech Republic
  11. First Department of Cardiology, Medical University of Gdansk, Poland
  12. International European University, Kyiv, Ukraine

open access

Vol 6, No 4 (2021)
ORIGINAL ARTICLES
Published online: 2021-11-03

Abstract

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability. In many cases of TBI-related intracranial hemorrhage (ICH) is associated with a high risk of coagulopathy and may lead to an increased risk of hemorrhage growth. Therefore, tranexamic acid (TXA), which is known as an antifibrinolytic agent that reduces bleeding by inhibiting the breakdown of blood clots, might limit ICH expansion.  

MATERIAL AND METHODS: We aimed to quantify the effects of TXA in brain injury and thus performed a literaturę search using PubMed, Web of Science, Scopus, EMBASE, and Cochrane Center Register of Controlled Trials (CENTRAL) for studies that were published between the respective database inception, and April 10, 2021.  

RESULTS: A total of nine studies were identified; these included 5845 patients treated with, and 5380 treated without TXA. The 28-day or in-hospital mortality was 17.8% for the TXA group, compared with 19.3% for the no-TXA group (OR = 0.92; 95% CI: 0.83, 1.01; p = 0.08). At 6-months follow-up, mortality was 18.3% vs 19.9% (OR = 0.91; 95% CI: 0.63–1.31; p = 0.60), with and without TXA, respectively. A Glasgow Outcome Scale less than 4 points at 28-days follow-up was reported in 3 studies and was 29.8% vs 34.8% (OR = 0.91; 95% CI: 0.45, 1.82; p = 0.78), with and without TXA, respectively. No differences were found in adverse events between TXA and non-TXA groups.  

CONCLUSION: Our analysis found showed no statistical significance between TXA and non-TXA treatment of TBI patients, however, in the TXA group a trend to decrease 28-day mortality compared to non-TXA treatment was observed. More high-quality studies are needed to show the significant benefit of using TXA, especially in moderate and severe TBI patient groups.

Abstract

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability. In many cases of TBI-related intracranial hemorrhage (ICH) is associated with a high risk of coagulopathy and may lead to an increased risk of hemorrhage growth. Therefore, tranexamic acid (TXA), which is known as an antifibrinolytic agent that reduces bleeding by inhibiting the breakdown of blood clots, might limit ICH expansion.  

MATERIAL AND METHODS: We aimed to quantify the effects of TXA in brain injury and thus performed a literaturę search using PubMed, Web of Science, Scopus, EMBASE, and Cochrane Center Register of Controlled Trials (CENTRAL) for studies that were published between the respective database inception, and April 10, 2021.  

RESULTS: A total of nine studies were identified; these included 5845 patients treated with, and 5380 treated without TXA. The 28-day or in-hospital mortality was 17.8% for the TXA group, compared with 19.3% for the no-TXA group (OR = 0.92; 95% CI: 0.83, 1.01; p = 0.08). At 6-months follow-up, mortality was 18.3% vs 19.9% (OR = 0.91; 95% CI: 0.63–1.31; p = 0.60), with and without TXA, respectively. A Glasgow Outcome Scale less than 4 points at 28-days follow-up was reported in 3 studies and was 29.8% vs 34.8% (OR = 0.91; 95% CI: 0.45, 1.82; p = 0.78), with and without TXA, respectively. No differences were found in adverse events between TXA and non-TXA groups.  

CONCLUSION: Our analysis found showed no statistical significance between TXA and non-TXA treatment of TBI patients, however, in the TXA group a trend to decrease 28-day mortality compared to non-TXA treatment was observed. More high-quality studies are needed to show the significant benefit of using TXA, especially in moderate and severe TBI patient groups.

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Keywords

blood conservation, antifibrinolytic, tranexamic acid, hemostasis, head trauma, meta-analysis

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About this article
Title

Place of tranexamic acid in traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 6, No 4 (2021)

Article type

Research paper

Pages

155-163

Published online

2021-11-03

Page views

6230

Article views/downloads

445

DOI

10.5603/DEMJ.a2021.0029

Bibliographic record

Disaster Emerg Med J 2021;6(4):155-163.

Keywords

blood conservation
antifibrinolytic
tranexamic acid
hemostasis
head trauma
meta-analysis

Authors

Mahdi Al-Jeabory
Lukasz Szarpak
Zubaid Rafique
Nilesh R. Vasan
Kecskes Attila
Aleksandra Gasecka
Wladyslaw Gawel
Michal Pruc
Marek Malysz
Milosz J. Jaguszewski
Ivan Savytskyi
Natasza Blek
Krzysztof J. Filipiak
Frank W. Peacock

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