Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis of Independent Factors Associated with Lower Mortality

Chan, David; Tsang, Anderson Chun On; Li, Lai Fung; Cheng, Kevin K F; Tsang, Frederick Chun Pong; Taw, Benedict Beng Teck; Pu, Jenny Kan Suen; Ho, Wendy; Lui, Wai Man; Leung, Gilberto Ka Kit

doi:10.1016/j.wneu.2019.01.145

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…However, the meaningfulness of these possibly distorted results is questionable, and their impact on heterogeneity when pooling data for overall mortality needs to be considered. Information on age, sex, or ISS was missing in several RCTs 2,13,14 and observational studies [16][17][18]35,40 ; their impact on heterogeneity is thus unknown. Moreover,…”

Section: Discussionmentioning

confidence: 99%

“…With the exception of 7 observational studies, 16,17,27,29,31,38,40 all studies had reported thromboembolic events. Twelve studies 3,14,19,[21][22][23][24][25]30,32,33,37 revealed higher and 8 studies 2,4,13,18,20,28,36,39 revealed lower incidences of thromboembolic events for tranexamic acid treatment compared with the control cohort. Three studies 26,34,35 could not find any association (RR, 1.00) between tranexamic acid administration and thromboembolic events.…”

Section: Association Between Tranexamic Acid and Thromboembolic Event...mentioning

confidence: 97%

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Association of Tranexamic Acid Administration With Mortality and Thromboembolic Events in Patients With Traumatic Injury

et al. 2022

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IMPORTANCETranexamic acid is widely available and used off-label in patients with bleeding traumatic injury, although the literature does not consistently agree on its efficacy and safety. OBJECTIVE To examine the association of tranexamic acid administration with mortality and thromboembolic events compared with no treatment or with placebo in patients with traumatic injury in the literature. DATA SOURCES On March 23, 2021, PubMed, Embase, and the Cochrane Library were searched for eligible studies published between 1986 and 2021. STUDY SELECTION Randomized clinical trials and observational studies investigating tranexamic acid administration compared with no treatment or placebo among patients with traumatic injury and traumatic brain injury who were 15 years or older were included. Included studies were published in English or German. The electronic search yielded 1546 records, of which 71 were considered for full-text screening. The selection process was performed independently by 2 reviewers. DATA EXTRACTION AND SYNTHESIS The study followed the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted by 2 independent reviewers and pooled using the inverse-variance random-effects model. MAIN OUTCOMES AND MEASURESOutcomes were formulated before data collection and included mortality at 24 hours and 28 and 30 days (1 month) as well as the incidence of thromboembolic events and the amount of blood products administered. Owing to missing data, overall mortality was added and the amount of blood products administered was discarded. RESULTSThirty-one studies with a total of 43 473 patients were included in the systematic review.The meta-analysis demonstrated that administration of tranexamic acid was associated with a significant decrease in 1-month mortality compared with the control cohort (risk ratio, 0.83 [95% CI, 0.71-0.97]; I 2 = 35%). The results of meta-analyses for 24-hour and overall mortality and thromboembolic events were heterogeneous and could not be pooled. Further investigations on clinical heterogeneity showed that populations with trauma and trial conditions differed markedly. CONCLUSIONS AND RELEVANCEThese findings suggest that tranexamic acid may be beneficial in various patient populations with trauma. However, reasonable concerns about potential thromboembolic events with tranexamic acid remain.

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Section: Discussionmentioning

confidence: 99%

Section: Association Between Tranexamic Acid and Thromboembolic Event...mentioning

confidence: 97%

Association of Tranexamic Acid Administration With Mortality and Thromboembolic Events in Patients With Traumatic Injury

et al. 2022

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“…Aside from the included studies, there was an observational study reported that TXA administration in patients with cerebral contusions or traumatic subarachnoid hemorrhage was independently associated with a reduced mortality rate [22]. An RCT showed that TXA was associated with reduced intraoperative bleeding but not hemoglobin change in patients with epidural, subdural, and intraparenchymal hemorrhage [23,24].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

July

Pranata

2020

BMC Neurol

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Background: This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). Methods:We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2020 from several electronic databases.Results: There were 30.522 patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p = 0.002; I 2 : 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p = 0.03; I 2 : 0%). Both TXA and control group has a similar need for neurosurgical intervention (p = 0.87) and unfavourable Glasgow Outcome Scale (GOS) (p = 0.59). The rate for vascular occlusive events (p = 0.09), and its deep vein thrombosis subgroup (p = 0.23), pulmonary embolism subgroup (p = 1), stroke subgroup (p = 0.38), and myocardial infarction subgroup (p = 0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p = 0.04; I 2 : 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group.Conclusion: TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias.

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“…However, various complications and functional defects encountered by the surviving patients in the recovery period are still important factors affecting their quality of life [7]. Although many SAH patients can achieve self-care after treatment, they show different degrees of anxiety, depression, and other mental symptoms, leading to their return to normal social life [8]. Thus, new treatment approaches are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Alantolactone reduced neuron injury via activating PI3K/Akt signaling pathway after subarachnoid hemorrhage in rats

et al. 2022

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Subarachnoid hemorrhage (SAH) is a common disease with high morbidity and mortality, which can cause pathological, physiological, and biological reactions. SAH causes a series of responses such as neuronal and cerebral cortex damage, which in turn leads to inflammation and apoptosis. Traditional Chinese medicine has a strong anti-inflammatory effect, such as Alantolactone (ATL). However, studies on ATL therapy for SAH have not been reported. We observed the neurological scores, brain water content, Evans blue (EB) extravasation, neuroinflammation, and apoptosis via performing an enzyme-linked immunosorbent assay (ELISA), western blotting, immunofluorescence staining, and other methods after SAH. In this study, we found that ATL treatment attenuated the neurologic deficits, inhibited neuronal apoptosis and inflammatory reaction, promoted polarization of microglia toward the M2 phenotype, and activated the PI3K/Akt signaling pathway. ATL can reduce the neurons and cerebral cortex damage of SAH rats through activating PI3K/Akt signaling pathway.

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Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis of Independent Factors Associated with Lower Mortality

Cited by 9 publications

References 23 publications

Association of Tranexamic Acid Administration With Mortality and Thromboembolic Events in Patients With Traumatic Injury

Association of Tranexamic Acid Administration With Mortality and Thromboembolic Events in Patients With Traumatic Injury

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

Alantolactone reduced neuron injury via activating PI3K/Akt signaling pathway after subarachnoid hemorrhage in rats

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