Efficacy of tranexamic acid in traumatic brain injury: Updated systematic review and meta-analysis

Abstract

Background and objectives

There is weak evidence for the efficacy of tranexamic acid in decreasing traumatic brain injury complications or improving clinical and radiological outcomes. We conducted a systematic review and meta-analysis to update the current evidence and to assess the efficacy of tranexamic acid in different outcomes.

Methods

A computer literature search of Medline, Web of Science, Scopus, and Cochrane central register of controlled trials was performed to identify relevant articles including only randomized-controlled trials. RevMan 5.3 software was used for data analysis.

Results

Four randomized-controlled trials were included. All studies were included in the quantitative and qualitative analysis. The analysis showed significant reduction of intracranial hemorrhage growth (progression) events (risk ratio = 0.77; 95% confidence interval 0.61 to 0.98), with no significant difference in reduction of total (volumetric) hemorrhage growth (mean difference = −2.46; 95% confidence interval −6.53 to 1.60; p = 0.23). There was no difference in risk between tranexamic acid and placebo for mortality (risk ratio = 0.64; 95% confidence interval 0.41 to 1), need for neurosurgical intervention (risk ratio = 0.96; 95% confidence interval 0.61 to 1.51), re-bleed (new hemorrhage) (risk ratio = 0.90; 95% confidence interval 0.57 to 1.41), hemorrhagic mass pressure effect on brain tissue (risk ratio = 0.81; 95% confidence interval 0.65 to 1.01), or unfavorable functional status at discharge (risk ratio = 0.78; 95% confidence interval 0.57 to 1.06).

Conclusions

Tranexamic acid significantly reduced intracranial hemorrhage growth events. There were non-significant results for all other included radiological and clinical outcomes. Large trials are needed for further exploration of the efficacy and proper dosing.