Tranexamic acid in non-traumatic intracranial bleeding: a systematic review and meta-analysis

Bouillon‐Minois, Jean‐Baptiste; Croizier, Carolyne; Baker, Julien S.; Pereira, Bruno; Moustafa, Farès; Outrey, Justin; Schmidt, Jeannot; Peschanski, Nicolas; Dutheil, Frédéric

doi:10.1038/s41598-021-94727-y

Cited by 16 publications

(15 citation statements)

References 42 publications

(90 reference statements)

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“…The findings of the current study are comparable with previous systematic reviews and meta-analyses regarding the use of TXA in aSAH ( 24 , 25 , 28 ). In 2013, Baharoglu et al evaluated the effect of antifibrinolytic therapy in aSAH; the study included two antifibrinolytic drugs, TXA and epsilon-aminocaproic acid ( 25 ).…”

Section: Discussionsupporting

confidence: 90%

“…The findings of the current study are comparable with previous systematic reviews and meta-analyses regarding the use of TXA in aSAH (24,25,28). In 2013, Baharoglu al.…”

Section: Discussionsupporting

confidence: 90%

“…Regarding the included studies, Baharoglu et al ( 25 ) had not included the studies by Post ( 29 ), Gibbs ( 39 ), Fodstad ( 35 ), and Fodstad ( 32 ), which were included in our study. In 2021, Bouillon-Minois et al investigated the mortality in patients receiving TXA for nontraumatic intracranial bleeding, comprising SAH and intracranial bleeding, not aSAH alone ( 28 ). The results of their subgroup analysis showed a reduction in mortality in SAH, which was not in agreement with our study.…”

Section: Discussionmentioning

confidence: 99%

“…It is likely that an increase in the risk of cerebral ischemia offset the effect of TXA on rebleeding ( 24 , 25 ). However, a recent study demonstrated that TXA may have a significant benefit on mortality in non-traumatic intracranial bleeding patients ( 28 ). Given the conflicting evidence, we cannot conclude whether TXA should routinely be used in patients with aSAH.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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Tranexamic acid has been shown to reduce rebleeding after aneurysmal subarachnoid hemorrhage; however, whether it can reduce mortality and improve clinical outcomes is controversial. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of the tranexamic acid in aneurysmal subarachnoid hemorrhage. We conducted a comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane Library from inception to March 2021 for randomized controlled trials (RCTs) comparing tranexamic acid and placebo in adults with aneurysmal subarachnoid hemorrhage. The risk of bias was evaluated using the Cochrane Handbook, and the quality of evidence was evaluated using the GRADE approach. This meta-analysis included 13 RCTs, involving 2,888 patients. In patients with aneurysmal subarachnoid hemorrhage tranexamic acid had no significant effect on all-cause mortality (RR = 0.96; 95% CI = 0.84–1.10, p = 0.55, I2 = 44%) or poor functional outcome (RR = 1.04; 95% CI = 0.95–1.15, p = 0.41) compared with the control group. However, risk of rebleeding was significantly lower (RR = 0.59; 95% CI = 0.43–0.80, p = 0.0007, I2 = 53%). There were no significant differences in other adverse events between tranexamic acid and control treatments, including cerebral ischemia (RR = 1.17; 95% CI = 0.95–1.46, p = 0.15, I2 = 53%). At present, routine use of tranexamic acid after subarachnoid hemorrhage cannot be recommended. For a patient with subarachnoid hemorrhage, it is essential to obliterate the aneurysm as early as possible. Additional higher-quality studies are needed to further assess the effect of tranexamic acid on patients with subarachnoid hemorrhage.

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Section: Discussionsupporting

confidence: 90%

“…The findings of the current study are comparable with previous systematic reviews and meta-analyses regarding the use of TXA in aSAH (24,25,28). In 2013, Baharoglu al.…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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“…Na předchozí práci WOMAN [28] navázala publikace Senthiles et al [29], která prokázala snížení krevní ztráty po podání TXA u žen podstupujících porod sekcí, ale také bezpečnost tohoto postupu stran rozvoje tromboembolických komplikací v následujících 3 měsících. Tři rozsáhlé publikované metaanalýzy prokazují benefit podání TXA u rodiček [30], traumat [31] a netraumatického nitrolebního krvácení [32]. Naopak bezpečnost podání TXA za různých okolností byla prokázána metaanalýzou 216 studií (125 550 pacientů) uveřejněnou v JAMA [33].…”

Section: Zástava Oběhuunclassified

Year 2021 in review - Intensive care

Beneš¹,

Chvojka²,

Karvunidis³

et al. 2022

Anest. intenziv. Med.

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Rok 2021 proběhl ve stínu běžící pandemie onemocnění covid-19. To se podepsalo nejen na množství ošetřených pacientů, ale také na zaměření naprosté většiny významných publikací. Přesto lze identifikovat několik publikačních počinů, které se vážou k běžné agendě oboru Intenzivní medicína. K těm předním patří publikace doporučených postupů resuscitace a péče o pacienty v septickém šoku. V tomto přehledovém článku přinášíme čtenářům časopisu výběr toho nejpodstatnějšího, co bylo v tomto roce publikováno a nemělo by utéct pozornosti.

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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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Tranexamic acid in non-traumatic intracranial bleeding: a systematic review and meta-analysis

Cited by 16 publications

References 42 publications

Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Year 2021 in review - Intensive care

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

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