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Effect of tranexamic acid in patients with traumatic brain injury: a systematic review and meta-analysis
Weng S, Wang W, Wei Q, Lan H, Su J, Xu Y
World neurosurgery. 2018
Abstract
OBJECTIVE Tranexamic acid (TXA) reduces hemorrhage volume and consequently the need for operative intervention. However, its effectiveness and safety in traumatic brain injury (TBI) patients is unclear. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of TXA in TBI patients. METHODS In July 2018, a systematic search for studies including TBI patients treated with TXA was conducted using PubMed, Embase, and the Cochrane Library databases. Only related RCT were included. Main outcomes included hematoma expansion, surgery rate, death rate, neurological outcome, and any thrombosis events. RESULTS Of the identified 426 studies, five RCTs 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 TBI patients. Regarding clinical outcomes, pooled results of surgery, mortality, and neurological 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 neurological 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 neurological outcomes in TBI patients, while not affecting thrombosis event rates. In addition, early TXA treatment is more effective in decreasing hematomas.