Efficacy of tranexamic acid in adult isolated traumatic brain injury: A multicenter retrospective study

To evaluate the association between tranexamic acid (TXA) and neurological outcome, including mortality, in isolated traumatic brain injury (TBI), considering the severity of TBI.

This multicenter, retrospective, cross-sectional study was conducted using Japan Trauma Data Bank from 2019 to 2023. Patients aged ≥18 years with TBI not complicated by extracranial injury who underwent computed tomography imaging within 3 h of injury were included. The primary outcome was in-hospital mortality and the secondary outcome was poor neurological outcome at hospital discharge, defined as a Glasgow Outcome Scale score of 1-3. The association between TXA administration and clinical outcomes was assessed using logistic regression adjusted by propensity score-based inverse probability of treatment weighting (IPTW). TBI severity was classified using the Glasgow Coma Scale scores as severe (3-8), moderate (9-12), or mild (13-15) to further evaluate the outcomes.

During the study period, 5732 patients were included, and the main analysis was conducted on 5639 patients excluding those with missing valiables. After IPTW, TXA was not associated with in-hospital mortality (adjusted odds ratio [aOR], 0.82; 95 % confidence interval [CI], 0.66-1.01) nor poor neurological outcome (aOR, 1.01; 95 % CI, 0.79-1.30). In the subgroup analysis according to TBI severity, in-hospital mortality was significantly lower in the TXA group only in patients with severe TBI (aOR, 0.78; 95 % CI, 0.63-0.97).

Our study found that TXA is associated with reduced mortality only in patients with isolated severe TBI.