Effect of Tranexamic Acid in Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

OBJECTIVE: Tranexamic acid (TXA) reduces hemorrhage volume and consequently the need for operative intervention. However, its effectiveness and safety in patients with traumatic brain injury (TBI) is unclear. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of TXA in patients with TBI. METHODS: In July 2018, a systematic search for studies including patients with TBI treated with TXA was conducted using PubMed, Embase, and the Cochrane Library databases. Only related randomized controlled trials were included. Main outcomes included hematoma expansion, surgery rate, death rate, neurologic outcome, and any thrombosis events. RESULTS: Of the identified 426 studies, 5 randomized controlled trials involving 917 patients met our inclusion criteria. For hematoma expansion, pooled results showed that TXA significantly decreased hemorrhage growth rate and total hemorrhage growth in patients with TBI. Regarding clinical outcomes, pooled results of surgery, mortality, and neurologic outcome showed no significant difference between the groups, and rate of thrombosis events was similar. Following sensitivity analysis, one study was excluded due to low quality. Then, results of TXA effect on mortality and neurologic outcomes became significant. We confirm that the earlier the TXA treatment is performed, the smaller the size of hematoma will be. CONCLUSIONS: TXA demonstrates significant effect in reducing the risk of hematoma expansion by lowering the mortality rate and improving favorable neurologic outcomes in patients with TBI while not affecting thrombosis event rates. In addition, early TXA treatment is more effective in decreasing hematomas.