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Updated: Jun 12, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Optimal dose of tranexamic acid in traumatic brain injury: Systematic review and network meta-analysis of randomized
Shu Utsumi1, Akiko Kawakami, Yu Amemiya
1From the Department of Emergency and Critical Care Medicine (S.U.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima; Department of Emergency Medicine (A.K.), Veritas Hospital, Hyogo; and Department of Emergency and Critical Care Medicine (Y.A.), Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Background:
Tranexamic acid (TXA) has been used to treat traumatic brain injury (TBI); however, no definitive conclusions have been drawn regarding its effectiveness or dosage. This study evaluated the optimal TXA dose for treating TBI using a network meta-analysis (NMA).
Methods:
Five databases were searched for peer-reviewed randomized controlled trials (RCTs) published from inception to May 2024. The inclusion criteria were as follows: (1) RCTs, (2) patients older than 1 month with TBI, (3) interventions of TXA and control, (4) primary outcomes of mortality and poor neurological outcomes and secondary outcomes of vascular occlusive events, and (5) full-text peer-reviewed articles. Two reviewers independently screened and extracted the data and assessed the risk of bias. Frequency-based NMA was performed using the Grading of Recommendations, Assessment, Development, and Evaluation working-group approach.
Results:
We included 10 RCTs comprising 11,237 patients with TBI. Placebo showed higher mortality compared with that of a 2-g bolus of TXA (risk ratio, 1.53; 95% confidence interval, 1.08-2.17). Higher mortality was observed with a 1-g bolus of TXA followed by 1-g maintenance TXA compared with that of a 2-g bolus of TXA (risk ratio, 1.44; 95% confidence interval, 1.02-2.03). No significant differences in poor neurological outcomes or vascular occlusive events were observed between the treatment groups.
Conclusion:
Placebo and a 1-g bolus followed by 1-g maintenance TXA were associated with higher mortality rates than those of a 2-g bolus of TXA. No difference in vascular occlusive events was observed with either treatment, indicating that our NMA recommends 2 g of TXA. However, the data for the 2-g bolus of TXA were from a single study, and further research is needed to draw definitive conclusions.
Level Of Evidence:
Systematic Review/Meta-Analysis; Level III.
