Appraising the use of tranexamic acid in traumatic and non‐traumatic intracranial hemorrhage: A narrative review

Abstract

Recently there has been increasing interest and debate on the use of tranexamic acid (TXA), an antifibrinolytic drug, in both traumatic and non‐traumatic intracranial hemorrhage. In this review we aim to discuss recent investigations looking at TXA in traumatic brain injury (TBI) and different categories of spontaneous intracranial hemorrhage. We also discuss differences between setting (hospital vs pre‐hospital), dosing and timing strategies, and other logistical challenges surrounding optimal use of TXA for isolated intracranial hemorrhage. Last, we hope to provide guidance for clinicians when considering the use of TXA in a patient with traumatic or non‐traumatic intracranial hemorrhage based on appraisal of the available literature as well as some potential ideas for future research in this area.

The effects of the COVID‐19 pandemic blood shortage on trauma patients

“…22,42 Restrictive transfusion thresholds which have already been well supported by data 43 were adhered to more strictly, and particularly in situations with consistently high transfusion requirements such as in ECMO existing data were used to justify these restrictive transfusion practices. 25 To minimize blood loss liberal use of tranexamic acid was encouraged in the intraoperative setting (particularly in neurologic, cardiac, orthopedic, and obstetric surgeries) 44 as well as for trauma patients. 42,45,46 Canceling elective procedures was officially recommended by the ACS 47 and other national bodies 25,48 as this dealt with the immediate blood demand.…”