Impact of Tranexamic Acid on Outcomes in Elderly Patients with Acute Traumatic Brain Injury

Although tranexamic acid (TXA) has demonstrated mortality benefit after traumatic brain injury (TBI), its effectiveness in older TBI patients-among whom the incidence of TBI is rapidly increasing-remains uncertain.

We conducted a multicenter retrospective cohort study using a prospectively maintained neuro-intensive care unit (ICU) registry across 6 centers in Korea. Patients aged ≥75 years with TBI who presented within 3 hours of injury and had intracranial hemorrhage on initial brain imaging were included. The primary outcome was ICU mortality. Secondary outcomes included clinical deterioration within 24 hours, neurological trajectories during ICU stay, and 6-month functional recovery. Associations between TXA and outcomes were evaluated using multivariable logistic regression and ordinal generalized estimating equation analysis.

Among 155 elderly patients with TBI (mean age 82±5 years; median GCS 11; 78% injured by ground-level falls), 93 (60%) received TXA. Overall ICU mortality was 30%. TXA administration was associated with lower ICU mortality (adjusted odds ratio [aOR], 0.35; 95% CI, 0.13-0.91) and reduced clinical deterioration within 24 hours (aOR = 0.17; 95% CI: 0.03-0.68). The mortality benefit was more pronounced in patients receiving antiplatelet therapy. In non-surgically managed patients, TXA use was associated with more stable daily GCS trajectories over the first 7 days of ICU stay. No significant differences were observed in 6-month functional outcomes.

In very elderly patients with TBI, TXA administration was associated with favorable early clinical outcomes, including lower ICU mortality and more stable early neurological trajectories, without improvement in long-term functional recovery.