Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double‐Blind, Placebo-Controlled Trial

Ebrahimi, Pouya; Mozafari, Javad; Ilkhchi, Reza Bahrami; Hanafi, Mohammad Ghasem; Mousavinejad, Maryam

doi:10.2174/1574887114666190620112829

Cited by 27 publications

(25 citation statements)

References 24 publications

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“…Aside from the included studies, there was an observational study reported that TXA administration in patients with cerebral contusions or traumatic subarachnoid hemorrhage was independently associated with a reduced mortality rate [22]. An RCT showed that TXA was associated with reduced intraoperative bleeding but not hemoglobin change in patients with epidural, subdural, and intraparenchymal hemorrhage [23,24].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

July

Pranata

2020

BMC Neurol

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Background: This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). Methods:We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2020 from several electronic databases.Results: There were 30.522 patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p = 0.002; I 2 : 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p = 0.03; I 2 : 0%). Both TXA and control group has a similar need for neurosurgical intervention (p = 0.87) and unfavourable Glasgow Outcome Scale (GOS) (p = 0.59). The rate for vascular occlusive events (p = 0.09), and its deep vein thrombosis subgroup (p = 0.23), pulmonary embolism subgroup (p = 1), stroke subgroup (p = 0.38), and myocardial infarction subgroup (p = 0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p = 0.04; I 2 : 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group.Conclusion: TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias.

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Section: Discussionmentioning

confidence: 99%

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

July

Pranata

2020

BMC Neurol

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“…If TXA is used as soon as possible after trauma, TXA may reduce death rate on mild to moderate TBI patients without increasing occlusive vascular event risk. In additionally, Ebrahimi et al 24) reported that TXA may reduce surgery related bleeding in patient with SDH and EDH. Mean amount of bleeding during surgery was lower in receiving TAX groups compared to the placebo groups.…”

Section: Critical Care Of Asdhmentioning

confidence: 98%

Neurocritical Management of Traumatic Acute Subdural Hematomas

Shin

Hwang

2020

Korean J Neurotrauma

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Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

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“…Two authors independently abstracted data and assessed the quality of evidence. We extracted the following information from included studies [13][14][15][16][17][18][19][20][21][22][23][24][25] : study author and years, study design, demographic data, ages and sexes of participants, details of the intervention, and risk of bias. We extracted the results of the included study as follow: mortality, severe TBI (Glasgow Coma Scale from 3 to 8), unfavorable Glasgow Outcome Scale (GOS < 4), neurosurgical intervention, mean hemorrhage volume, the number people of new bleeding, adverse events including vascular occlusive events, pulmonary embolism (PE), deep vein thrombosis (DVT), neurological complications (including stroke and seizure), gastrointestinal bleeding, myocardial infarction, infectious complications, renal failure.…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…By reading the title and abstract, 547 articles were excluded, yielding 126 studies. Of these, full text was assessed, leading to the exclusion of another 113 studies, resulting in 13 studies that were included in the analysis [13][14][15][16][17][18][19][20][21][22][23][24][25] . Studies were conducted in patients undergoing TBI patients.…”

Section: Literature Searchmentioning

confidence: 99%

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The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

Huang

Xin

et al. 2022

Preprint

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Objective: Tranexamic acid (TXA) has been shown to play a significant role in the treatment of trauma diseases. However, its effectiveness in patients with traumatic brain injury (TBI) seems to be contradictory according to the recent publication of several meta-analyses. We aim to determine the efficacy of TXA treatment with different time and doses for TBI.Methods: PubMed, MEDLINE, EMBASE, Cochrane library and Google scholar were searched for randomized (RCT) that compared TXA and placebo in adults and adolescents (≥ 15 years of age) with TBI, up to January 31, 2022. Two authors independently abstracted data and assessed the quality of evidence. Results: Of the identified 673 studies, 13 trials involving 18,675 patients met our inclusion criteria. TXA had no effect on mortality (RR 0.99; 95% CI 0.92–1.06), adverse events (RR 0.93, 95% Cl 0.76-1.14), severe TBI (Glasgow Coma Scale score from 3 to 8) (RR 0.99, 95% Cl 0.94-1.05), unfavorable Glasgow Outcome Scale (GOS <4) (RR 0.96, 95% Cl 0.82-1.11), neurosurgical intervention (RR 1.11, 95%Cl 0.89-1.38), or new bleeding (RR 0.97, 95%Cl 0.82-1.16). TXA might reduce mean hemorrhage volume on subsequent imaging (SMD -0.35; 95% CI [-0.62, -0.08]).Conclusion: TXA at different times and doses was associated with reduced mean bleeding, but not with mortality, adverse events, neurosurgical intervention and new bleeding. We need more research data on different detection indexes and levels of TXA in patients with TBI, as compared to those not receiving TXA although the prognostic outcome for all harm outcomes was no effect, did not rule out the potential for harm. Trial registrationThe review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022300484).

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Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double‐Blind, Placebo-Controlled Trial

Cited by 27 publications

References 24 publications

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

Tranexamic acid is associated with reduced mortality, hemorrhagic expansion, and vascular occlusive events in traumatic brain injury – meta-analysis of randomized controlled trials

Neurocritical Management of Traumatic Acute Subdural Hematomas

The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

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