Tranexamic Acid for Traumatic Brain Injury

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Tranexamic acid for traumatic braininjury: a systematic review

and meta-analysis

Shahriar Zehtabchi, MD a,

Samah G !bdel "a#i,MDa,$ouise %al&on, "!, Daniel '(ishijima, MD


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Trauma"rain )njury

• an estimated *+ million emerency deartment ./D0visits

• 123444 hositali&ations• 31444 deaths each year

Secondary

"rain )njury

• roressive intracranial bleedin, cerebral edema,increased intracranial ressure, subse5uent cerebral

ischemia• worsened by osttraumatic coauloathy

!nti6brinolytic aent

tranexamicacid .T7!0 • Does administration of T7! .intervention0 comared to

lacebo .comarison0 imrove atients8 outcomes suchas reduction inmortality, neuroloic function, andhemorrhae roression .outcome09utcome

)ntroduction


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Methods

•

Study Desin :;andomi&ed controlled trials .;


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Methods• Data extractionData from the identi6ed studies were abstracted indeendently by 1 of theauthors .SZ and SG!0 usin a standardi&ed form

• Buality assessmentCGradin 5uality of evidence and strenth of recommendations criteria to assess the

5uality of the included trial and rate the level of evidence

• Buantitative data synthesis The eEect of T7! on dichotomous outcomes was assessed usin a random eEects

model because the trials were exected to be heteroeneous in their desin andatient oulations ;elative ris# and >3F


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Methods


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Methods


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;esult


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Discussion

)mrovin the outcome of brain injury atients larelydeends on minimi&in the secondary brain insults

• Secondary insults include hematoma

exansion, cerebral edema, increasedintracerebral ressure, infection, hyoxia, andcoauloathy The brain tissue contains lare amounts of thrombolastin

This substance is released in hih concentration into theblood stream after hysical trauma to the arenchyma,

causin disturbance in coaulation rocesses• )n addition, damaed cerebral endothelium

activates latelets as well as clottin cascadesto roduce intravascular thrombosis and

deletion of coaulation factors


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Mechanism* T7!, as an anti6brinolytic aent,may limit 6brinolysis and thus )


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$imitations

There was some heteroeneity betweenidenti6ed studies, articularly in theinclusion criteria• The included studies did not account

for atients receivin anticoaulantsor antilatelet aents

The mechanism of injury could be a

confounder that needs to be examinedin future trials• The meta-analysiswas erformedwith

only 1 trials


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Tranexamic Acid for Traumatic Brain Injury

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