The effects of timing of prehospital tranexamic acid on outcomes after traumatic brain injury: Subanalysis of a randomized controlled trial

Brito, Alexandra Marie Pawliuk; Schreiber, Martin A.; Haddi, James El; Meier, Eric N.; Rowell, Susan

doi:10.1097/ta.0000000000003767

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Measurements were selected based on the literature review and the study purpose [5,13, 16]. Baseline characteristics included age, gender, body mass index (BMI); medical parameters at admission included hypertension history, diabetes history, Glasgow Coma Scale (GCS) score, heart rate, systolic blood pressure (SBP), and Spo2; time of TXA administration since head injury (TXAT, the injury time regarded as the time call for an emergency service dispatch), the mannitol and TXA administration interval (Time interval between the nurse's signature on the two medical orders).…”

Section: Measurementmentioning

confidence: 99%

“…This is the most signi cant medical and teaching hospital in North Sichuan Province, China, a certi cated province-level regional medical center and national trauma center, with more than 2000 referrals annually. Included criteria: (1) aged between 18 to 80 years, (2) diagnosed as TBI and recon rmed ICH by computer tomography, (3) de ned with a 3 ≤ Glasgow Coma Scale (GCS) score ≤ 12 at admission, (4) have received 2g TXA [13] and 50g mannitol during prehospital treatment, (5) TXA treatment administrated within two hours since the head injury [13], ( 6) at least have one pupil reaction. Excluded criteria: (1) have other intrinsic VTE risks mentioned by the Caprini score [14], (2) work or live at an altitude of more than 3,500 meters [15], (3) take warfarin or antiplatelet agent within one month, (4) received other hemostatic or dehydration agent during prehospital treatment, (5) died before hospitalized (6) systolic blood pressure < 90 mmHg at admission (7) Incomplete data.…”

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confidence: 99%

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For patients with TBI-related ICH, a shorter mannitol and tranexamic acid administration interval may contribute to VTE risk

luo,

yang,

et al. 2024

Preprint

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Background After the CRASH-3 trial, the debate on tranexamic acid (TXA) has never ended. As significant parts in traumatic brain injury-related intracranial hemorrhage pharmacologic therapies, we hypothesized that the shorter mannitol and TXA administration interval might increase those patients' VTE risk. Methods A retrospective study was conducted. Data were extracted through the China Trauma Rescue & Treatment Association database. Finally, 712 cases were included in the data analysis: the VTE group (n=45) and the non-VTE group (n=667). Then, a t-test, Pearson Chi-square test, and logistic regression were performed. Results the VTE group indicates significant aging (57.11±9.35, p=0.001), shorter mannitol and TXA administration interval (12.62±8.72, p=0.002), longer LHS (20.48±2.64,p<0.000), and higher D-dimer (6.05±2.59, p=0.001). By further logistic regression, the mannitol and TXA administration interval presents a relation with VTE occurrence with β=-0.053, OR=0.948, and P=0.004. Conclusion The mannitol and tranexamic acid administration interval might be an independent VTE risk for patients with TBI-related intracranial hemorrhage.

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Section: Measurementmentioning

confidence: 99%

mentioning

confidence: 99%

For patients with TBI-related ICH, a shorter mannitol and tranexamic acid administration interval may contribute to VTE risk

luo,

yang,

et al. 2024

Preprint

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“…In a mouse model of TBI, Wallen et al (177) demonstrated that TXA is neuroprotective but leads to a SIRS response with serum cytokine elevation. Both the CRASH-3 trial (172) and the Prehospital TXA for TBI Trial (175,178) had nonsignificant primary outcomes of TXA versus placebo. However, these studies demonstrated the safety of TXA in TBI patients.…”

Section: Tranexamic Acidmentioning

confidence: 99%

The neuro-endothelial axis in traumatic brain injury: mechanisms of multi-organ dysfunction, novel therapies, and future directions

Ho,

Dawood,

Taylor

et al. 2024

Shock

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Severe traumatic brain injury (TBI) often initiates a systemic inflammatory response syndrome (SIRS), which can potentially culminate into multi-organ dysfunction (MOD). A central player in this cascade is endotheliopathy, caused by perturbations in homeostatic mechanisms governed by endothelial cells due to injury-induced coagulopathy, heightened sympathoadrenal response, complement activation, and pro-inflammatory cytokine release. Unique to TBI is the potential disruption of the blood-brain barrier (BBB), which may expose neuronal antigens to the peripheral immune system and permit neuroinflammatory mediators to enter systemic circulation, propagating endotheliopathy systemically. This review aims to provide comprehensive insights into the “neuro-endothelial axis” underlying endothelial dysfunction following TBI, identify potential diagnostic and prognostic biomarkers, and explore therapeutic strategies targeting these interactions, with the ultimate goal of improving patient outcomes following severe TBI.

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“…TXA administration in the prehospital environment has been extensively investigated in recent years. 31,32 Several large, highquality studies have failed to support benefit for most braininjured patients, leading to a strong recommendation against routine use in these guidelines. The Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma study was a large prospective observational study of 1827 patients which reported increased mortality in patients treated with TXA (odds ratio 1.34, P < .001).…”

Section: Tranexamic Acidmentioning

confidence: 99%

Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

Hawryluk,

Lulla,

Bell

et al. 2023

Neurosurgery

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Prehospital care markedly influences outcome from traumatic brain injury, yet it remains highly variable. The Brain Trauma Foundation's guidelines informing prehospital care, first published in 2002, have sought to identify and disseminate best practices. Many of its recommendations relate to the management of airway, breathing and circulation, and infrastructure for this care. Compliance with the second edition of these guidelines has been associated with significantly improved survival. A working group developed evidence-based recommendations informing assessment, treatment, and transport decision-making relevant to the prehospital care of brain injured patients. A literature search spanning May 2005 to January 2022 supplemented data contained in the 2nd edition. Identified studies were assessed for quality and used to inform evidence-based recommendations. A total of 122 published articles formed the evidentiary base for this guideline update including 5 providing Class I evidence, 35 providing Class II evidence, and 98 providing Class III evidence for the various topics. Forty evidence-based recommendations were generated, 30 of which were strong and 10 of which were weak. In many cases, new evidence allowed guidelines from the 2nd edition to be strengthened. Development of guidelines on some new topics was possible including the prehospital administration of tranexamic acid. A management algorithm is also presented. These guidelines help to identify best practices for prehospital traumatic brain injury care, and they also identify gaps in knowledge which we hope will be addressed before the next edition.

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The effects of timing of prehospital tranexamic acid on outcomes after traumatic brain injury: Subanalysis of a randomized controlled trial

Abstract: In this study we examine the effect of early versus delayed prehospital administration of tranexamic acid in patients with traumatic brain injury. Outcomes were not significantly different but select complications were lower with early administration.

Cited by 8 publications

References 22 publications

For patients with TBI-related ICH, a shorter mannitol and tranexamic acid administration interval may contribute to VTE risk

For patients with TBI-related ICH, a shorter mannitol and tranexamic acid administration interval may contribute to VTE risk

The neuro-endothelial axis in traumatic brain injury: mechanisms of multi-organ dysfunction, novel therapies, and future directions

Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

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