Tranexamic acid in traumatic brain injury.
K B Nelson Yap1, S H Albert Wong2, Z Idris3
1Universiti Sains Malaysia, School of Medical Sciences, Department of Neurosciences, Kubang Kerian, Kelantan, Malaysia. nykb15@gmail.com.
The Medical Journal of Malaysia
|November 21, 2020
Summary
Tranexamic acid (TXA) significantly reduced clot expansion in traumatic brain injury (TBI) patients. While not improving overall outcomes, TXA showed benefits for moderate to severe acute subdural hemorrhage cases.
Area of Science:
- Neurosurgery
- Emergency Medicine
- Pharmacology
Background:
- Traumatic brain injury (TBI) is a significant cause of mortality and morbidity.
- The use of tranexamic acid (TXA) in TBI management is debated.
- TXA is an antifibrinolytic agent that may reduce bleeding in TBI.
Purpose of the Study:
- To evaluate the effectiveness and safety of TXA in TBI patients.
- To assess TXA's impact on patient outcomes, clot expansion, and mortality.
- To compare outcomes in TBI patients with and without TXA administration.
Main Methods:
- Prospective observational cohort study at Sarawak General Hospital, Malaysia.
- Recruited 334 patients (≥12 years) with mild to severe TBI within 8 hours of injury.
- 167 patients received TXA; 167 did not. Primary outcome: good outcome (GOSE ≥5). Secondary outcome: clot expansion (≥25% increase).
Main Results:
- TXA did not significantly improve overall good outcomes (GOSE) (p=0.763).
- Significant improvement in outcomes for moderate/severe acute subdural hemorrhage (SDH) subgroups (p=0.042).
- Clot expansion occurred in 12.7% with TXA vs. 38.8% without (p<0.001). One case of DVT (0.6%) in the TXA group. Mortality reduction was not significant (p=0.474).
Conclusions:
- TXA significantly reduces clot expansion in TBI by 26.1% without increasing thrombotic events.
- TXA can improve outcomes in moderate and severe TBI patients with acute SDH.
- Further research may clarify TXA's role in specific TBI subpopulations.
