Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials

Kumait Al Lawati^{1

2

3}, Sameer Sharif^{4

5}, Said Al Maqbali^{1

3}, Hussein Al Rimawi¹, Andrew Petrosoniak⁶, Emilie P Belley-Cote^{2

7}, Sunjay V Sharma^{2

8}, Justin Morgenstern⁹, Shannon M Fernando^{10

11}, Julian J Owen^{1

2}, Michelle Zeller¹², David Quinlan¹, Waleed Alhazzani^{2

13}, Bram Rochwerg^{2

13}

Affiliations

¹ Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Oman Medical Specialty Board (OMSB), Muscat, Sultanate of Oman.
⁴ Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada. sameer.sharif@medportal.ca.
⁵ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. sameer.sharif@medportal.ca.
⁶ Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Population Health Research Institute, Hamilton, ON, Canada.
⁸ Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁹ Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada.
¹³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 33079217
DOI: 10.1007/s00134-020-06279-w

Meta-Analysis

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials

Kumait Al Lawati et al. Intensive Care Med. 2021 Jan.

. 2021 Jan;47(1):14-27.

doi: 10.1007/s00134-020-06279-w. Epub 2020 Oct 20.

Authors

Affiliations

¹ Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Oman Medical Specialty Board (OMSB), Muscat, Sultanate of Oman.
⁴ Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada. sameer.sharif@medportal.ca.
⁵ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. sameer.sharif@medportal.ca.
⁶ Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Population Health Research Institute, Hamilton, ON, Canada.
⁸ Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁹ Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² McMaster Centre for Transfusion Research, McMaster University and Canadian Blood Services, Hamilton, Canada.
¹³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 33079217
DOI: 10.1007/s00134-020-06279-w

Abstract

Purpose: With the publication of a large randomized-controlled trial (RCT) suggesting that tranexamic acid (TXA) may improve head-injury-related deaths, we aimed to determine the safety and efficacy of TXA in acute traumatic brain injury (TBI).

Methods: In this systematic review and meta-analysis, we searched MEDLINE, PubMed, EMBASE, CINHAL, ACPJC, Google Scholar, and unpublished sources from inception until June 24, 2020 for randomized-controlled trials comparing TXA and placebo in adults and adolescents (≥ 15 years of age) with acute TBI. We screened studies and extracted summary estimates independently and in duplicate. We assessed the quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO (CRD42020164232).

Results: Nine RCTs enrolled 14,747 patients. Compared to placebo, TXA had no effect on mortality (RR 0.95; 95% CI 0.88-1.02; RD 1.0% reduction; 95% CI 2.5% reduction to 0.4% increase, moderate certainty) or disability assessed by the Disability Rating Scale (MD, - 0.18 points; 95% CI - 0.43 to 0.08; moderate certainty). TXA may reduce hematoma expansion on subsequent imaging (RR 0.77; 95% CI 0.58-1.03, RD 3.6%, 95% CI 6.6% reduction to 0.5% increase, low certainty). Risks of adverse events (all moderate, low, or very low certainty) were similar between placebo and TXA.

Conclusions: In patients with acute TBI, TXA probably has no effect on mortality or disability. TXA may decrease hematoma expansion on subsequent imaging; however, this outcome is likely of less importance to patients. The use of TXA probably does not increase the risk of adverse events.

Keywords: Brain injury; Clinical trial; Randomized; Tranexamic acid; Traumatic.

PubMed Disclaimer

Comment in

Tranexamic acid in traumatic brain injury: systematic review and meta-analysis trumps a large clinical trial?
Maas AIR, Steyerberg EW, Citerio G. Maas AIR, et al. Intensive Care Med. 2021 Jan;47(1):74-76. doi: 10.1007/s00134-020-06305-x. Epub 2020 Oct 31. Intensive Care Med. 2021. PMID: 33128570 No abstract available.

References

1. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A et al (2017) Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 16(12):987–1048 - DOI
1. De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG, Fernandes J et al (2009) Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries. Int J Epidemiol 38(2):452–458 - DOI
1. Taylor CA, Bell JM, Breiding MJ, Xu L (2017) Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ 66(9):1–16 - DOI
1. Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B et al (2005) Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 365(9475):1957–1959 - DOI
1. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M et al (2018) Estimating the global incidence of traumatic brain injury. J Neurosurg 130(4):1039–1408

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials

Affiliations

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials

Authors

Affiliations

Abstract

Comment in

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous