The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials

Chen, Hongshen; Chen, Muhu

doi:10.1016/j.ajem.2019.158499

Cited by 25 publications

(15 citation statements)

References 29 publications

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“…The other two meta-analysis further testified the progress of intracranial hemorrhage; however, the two meta-analysis demonstrated that TXA was associated with substantially reduced mortality [15,16]. These above metaanalysis [14][15][16][17] with TBI, and proved that TXA could reduce the mortality. Moreover, subgroup analysis found that treatment with TXA between GCS 3-8 and GCS 9-15 did not reach significance.…”

Section: Main Findings and Comparison With Previous Studiesmentioning

confidence: 96%

“…Two meta-analysis of RCTs indicated that TXA had significantly reduced intracranial hemorrhage progression but not mortality [14,17]. The other two meta-analysis further testified the progress of intracranial hemorrhage; however, the two meta-analysis demonstrated that TXA was associated with substantially reduced mortality [15,16]. These above metaanalysis [14][15][16][17] with TBI, and proved that TXA could reduce the mortality.…”

Section: Main Findings and Comparison With Previous Studiesmentioning

confidence: 99%

“…Several meta-analysis comparing TXA and placebo had been published [14][15][16][17]. Two meta-analysis of RCTs indicated that TXA had significantly reduced intracranial hemorrhage progression but not mortality [14,17].…”

Section: Main Findings and Comparison With Previous Studiesmentioning

confidence: 99%

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The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials

Liu

et al. 2020

Chin Neurosurg Jl

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To conduct a systematic review and meta-analysis and evaluate the effect of tranexamic acid in patients with traumatic brain injury. PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched to identify randomized controlled trials and evaluate the effect of tranexamic acid in traumatic brain injury patients. The primary outcome was mortality. Two reviewers extracted the data independently. The random effect meta-analysis was used to estimate the aggregate effect size of 95% confidence intervals. Six randomized controlled trials investigating tranexamic acid versus placebo and 30073 patients were included. Compared with placebo, tranexamic acid decreased the mortality (RR = 0.92; 95% CI, 0.87-0.96; p < 0.001) and growth of hemorrhagic mass (RR = 0.78; 95% CI, 0.61-0.99; p = 0.04). However, tranexamic acid could not decrease disability or independent, neurosurgery, vascular embolism, and stroke. Current evidence suggested that compared with placebo, tranexamic acid could reduce mortality and growth of hemorrhagic mass. This finding indicated that patients with traumatic brain injury should be treated with tranexamic acid.

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Section: Main Findings and Comparison With Previous Studiesmentioning

confidence: 96%

Section: Main Findings and Comparison With Previous Studiesmentioning

confidence: 99%

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The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials

Liu

et al. 2020

Chin Neurosurg Jl

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“…A meta-analysis of six randomized controlled trials (RCT) examining TXA in patients with primarily moderate or severe TBI identified decreased ICH progression and an overall reduction in mortality, although no effect on longterm neurologic outcome was observed. 76 In addition, no significant difference was found in the rate of thrombotic complications compared with placebo, a complication with particular relevance in the use of procoagulant therapies. In the CRASH-3 trial, which followed the publication of this metaanalysis, reduction in head-injury-related death was observed among patients with mild to moderate TBI who received TXA within 3 hours of injury with no increase in the incidence of vascular occlusive events.…”

Section: Tranexamic Acid In Traumatic Brain Injurymentioning

confidence: 98%

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Anderson

Farrell

Rowell

2021

Semin Thromb Hemost

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Posttraumatic coagulopathy involves disruption of both the coagulation and fibrinolytic pathways secondary to tissue damage, hypotension, and inflammatory upregulation. This phenomenon contributes to delayed complications after traumatic brain injury (TBI), including intracranial hemorrhage progression and systemic disseminated intravascular coagulopathy. Development of an early hyperfibrinolytic state may result in uncontrolled bleeding and is associated with increased mortality in patients with TBI. Although fibrinolytic assays are not routinely performed in the assessment of posttraumatic coagulopathy, circulating biomarkers such as D-dimer and fibrin degradation products have demonstrated potential utility in outcome prediction. Unfortunately, the relatively delayed nature of these tests limits their clinical utility. In contrast, viscoelastic tests are able to provide a rapid global assessment of coagulopathy, although their ability to reliably identify disruptions in the fibrinolytic cascade remains unclear. Limited evidence supports the use of hypertonic saline, cryoprecipitate, and plasma to correct fibrinolytic disruption; however, some studies suggest more harm than benefit. Recently, early use of tranexamic acid in patients with TBI and confirmed hyperfibrinolysis has been proposed as a strategy to further improve clinical outcomes. Moving forward, further delineation of TBI phenotypes and the clinical implications of fibrinolysis based on phenotypic variation is needed. In this review, we summarize the clinical aspects of fibrinolysis in TBI, including diagnosis, treatment, and clinical correlates, with identification of targeted areas for future research efforts.

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“…The CRASH-3 trial found that TXA decreased the risk of injury-related deaths in patients with mild-to-moderate head injury [ 5 ]. Similarly, a more recent meta-analysis found that the use of TXA for traumatic brain injury is associated with substantially reduced mortality and the extent of intracranial hemorrhage [ 6 ]. Our research of available literature however revealed no study which directly examined the utility of TXA for specifically isolated solid organ injuries (liver, kidney, and splenic injuries).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Tranexamic Acid in Reducing Hemorrhage in Isolated Blunt Solid Organ Injury

Kovalev¹,

Dong²,

Bagheri³

et al. 2021

Cureus

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Introduction: There is considerable interest in the use of tranexamic acid (TXA) for the control of hemorrhages in trauma patients. Multiple recent studies found that TXA used in the setting of a suspected significant hemorrhage in trauma patients significantly reduced mortality. To date, there are no cited studies that specifically address hemorrhage due to solid organ injury (i.e., kidneys, liver, and spleen) and TXA use in humans. Our current research addresses whether TXA is effective in reducing complications and mortality from traumatic hemorrhage in the setting of a specific solid organ injury.Methods: We conducted a retrospective observational cohort study utilizing propensity score matching at Arrowhead Regional Medical Center (ARMC) from February 1, 2009 to February 1, 2019. This study period marks five years prior to and five years after February 1, 2004, which is the date when TXA first started to be used at ARMC in the management of traumatic hemorrhage. We compared for statistical difference between corresponding injury types in the TXA and non-TXA groups.Results: Before the propensity matching, there were 123 patients who received TXA and 118 patients who did not. After propensity match for age and injury severity score (ISS), 35 patients were included in each group. We found no statistically significant difference between TXA and non-TXA treatment groups in terms of mortality at 24 hours (p-value=0.4945), mortality at 48 hours (p-value=0.4945), and mortality at 28 days (p-value=0.7426). We found no statistically significant difference between the need for interventional radiology intervention at 72 hours (p-value=0.3932), surgical intervention at 72 hours (p-value=0.2123) and possible TXA related complications (p-value=1).Conclusion: Although prior studies showed that TXA use in the setting of trauma may be beneficial, the specific candidate-selection criteria remain unclear. The results of our study suggest that the benefit from TXA in the setting of the isolated splenic, liver, and or renal injury may be negligible. We believe that this first-of-its-kind study adds to the growing body of knowledge about the utility of TXA and helps guide patient-selection criteria.

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The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials

Cited by 25 publications

References 29 publications

The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials

The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Effectiveness of Tranexamic Acid in Reducing Hemorrhage in Isolated Blunt Solid Organ Injury

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