The effect of prehospital tranexamic acid on outcome in polytrauma patients with associated severe brain injury

Wessem, Karlijn J. P. van; Jochems, Denise; Leenen, Luke P. H.

doi:10.1007/s00068-021-01827-5

Cited by 8 publications

(30 citation statements)

References 21 publications

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“…Thirteen articles were included, including eight single-site RCTs [ 15 – 20 , 26 , 27 ] and five multi-site RCTs [ 13 , 14 , 21 , 22 , 25 ]. The minimum age of the participants was greater than 15 years, which included both adults and adolescents.…”

Section: Resultsmentioning

confidence: 99%

“…The minimum age of the participants was greater than 15 years, which included both adults and adolescents. The timing of TXA administration varied among studies, with five trials in which the post-traumatic registration time was less than 3 h [ 13 , 15 , 17 , 19 , 25 ], seven trials in which the post-traumatic registration time was more than 3 h [ 14 , 16 , 18 , 19 , 21 , 26 , 27 ], and one article that did not clearly explain the registration time. In the included trials, the TXA dose was mostly similar, and the most common regimen was a loading dose of 1 g, followed by a maintenance dose of 1 g over 8 h [ 13 – 22 , 25 – 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Ten articles [ 13 , 15 – 22 , 25 , 26 ] reported the mortality of patients with TBI treated with TXA or a placebo. Meta-analysis showed that TXA was not associated with reduced mortality (RR 0.99; 95% CI 0.92–1.06, Fig.…”

Section: Resultsmentioning

confidence: 99%

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The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

Huang

Xin

et al. 2022

Thrombosis J

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Objective Tranexamic acid (TXA) plays a significant role in the treatment of traumatic diseases. However, its effectiveness in patients with traumatic brain injury (TBI) seems to be contradictory, according to the recent publication of several meta-analyses. We aimed to determine the efficacy of TXA treatment at different times and doses for TBI treatment. Methods PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar were searched for randomized controlled trials that compared TXA and a placebo in adults and adolescents (≥ 15 years of age) with TBI up to January 31, 2022. Two authors independently abstracted the data and assessed the quality of evidence. Results Of the identified 673 studies, 13 involving 18,675 patients met our inclusion criteria. TXA had no effect on mortality (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.92–1.06), adverse events (RR 0.93, 95% Cl 0.76–1.14), severe TBI (Glasgow Coma Scale score from 3 to 8) (RR 0.99, 95% Cl 0.94–1.05), unfavorable Glasgow Outcome Scale (GOS < 4) (RR 0.96, 95% Cl 0.82–1.11), neurosurgical intervention (RR 1.11, 95% Cl 0.89–1.38), or rebleeding (RR 0.97, 95% Cl 0.82–1.16). TXA might reduce the mean hemorrhage volume on subsequent imaging (standardized mean difference, -0.35; 95% CI [-0.62, -0.08]). Conclusion TXA at different times and doses was associated with reduced mean bleeding but not with mortality, adverse events, neurosurgical intervention, and rebleeding. More research data is needed on different detection indexes and levels of TXA in patients with TBI, as compared to those not receiving TXA; although the prognostic outcome for all harm outcomes was not affected, the potential for harm was not ruled out. Trial registration The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022300484).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

Huang

Xin

et al. 2022

Thrombosis J

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“…Recent observational studies have shown mixed results, including benefit as well as harm, as summarized in Table 1 [ 15 ▪ , 69 – 72 ]. Although these studies must be interpreted with caution given their inherent limitations, in particular confounding [ 73 ], they allow gauging potential treatment effects of TXA when used in regular clinical practice rather than under controlled trial conditions.…”

Section: Use Of Antifibrinolytic Drugs In Traumatic Brain Injurymentioning

confidence: 99%

Antifibrinolytics in the treatment of traumatic brain injury

Schober

Loer

Schwarte

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTraumatic brain injury (TBI) is a leading cause of trauma-related deaths, and pharmacologic interventions to limit intracranial bleeding should improve outcomes. Tranexamic acid reduces mortality in injured patients with major systemic bleeding, but the effects of antifibrinolytic drugs on outcomes after TBI are less clear. We therefore summarize recent evidence to guide clinicians on when (not) to use antifibrinolytic drugs in TBI patients. Recent findingsTranexamic acid is the only antifibrinolytic drug that has been studied in patients with TBI. Several recent studies failed to conclusively demonstrate a benefit on survival or neurologic outcome. A large trial with more than 12 000 patients found no significant effect of tranexamic acid on head-injury related death, allcause mortality or disability across the overall study population, but observed benefit in patients with mild to moderate TBI. Observational evidence signals potential harm in patients with isolated severe TBI.

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“…Such preclinical results need to be confirmed in prospective clinical trials to justify clinical use. Whether early TXA administration in polytrauma patients with TBI involvement has positive effects on outcome was investigated by van Wessem et al However, in a large-scale prospective cohort study with more than 200 severely injured patients included, no significant positive effect of TXA application could be demonstrated [ 7 ].…”

mentioning

confidence: 99%

Focus on biomarkers, confounders and new therapeutic approaches in trauma

Henrich

2022

Eur J Trauma Emerg Surg

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The effect of prehospital tranexamic acid on outcome in polytrauma patients with associated severe brain injury

Cited by 8 publications

References 21 publications

The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

Antifibrinolytics in the treatment of traumatic brain injury

Focus on biomarkers, confounders and new therapeutic approaches in trauma

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