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TXA for TBI – Meta-analysis of Nine RCTs

February 17, 2021

Written by Clay Smith

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In patients with acute traumatic brain injury (TBI), tranexamic acid (TXA) did not improve mortality or neurological outcome among survivors.

Why does this matter?
We’ve covered CRASH-3, which found a slight mortality benefit from TXA for TBI. Then we covered a prehospital RCT which showed no benefit from TXA, and the BRAIN-PROTECT group found possible harm from TXA in patients with severe or isolated TBI. What is the consensus report when we compile even more RCTs?

Hold the TXA for TBI
They found 9 RCTs, with 14,747 patients combined. TXA did not reduce mortality, risk ratio 0.95 (95%CI 0.88-1.02). It also didn’t improve neurological outcome when measured with validated disability scales. But it also didn’t seem to cause harm. I can’t advocate for the use of TXA for TBI, especially since the prehospital study by the BRAIN-PROTECT collaborators found harm and was not included in this meta-analysis. That RCT would have added another 1,827 patients to the meta-analysis and would likely have made these outcome results look worse. Tomorrow we will look at TXA for subarachnoid hemorrhage.

Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials. Intensive Care Med. 2021 Jan;47(1):14-27. doi: 10.1007/s00134-020-06279-w. Epub 2020 Oct 20.

What are your thoughts?