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Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature

Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri

DOI: https://doi.org/10.13107/ti.2022.v08i02.027


Authors: Kenzie Kao [1], Mohammed Alsabri [2]

[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.

Address of Correspondence

Dr. Mohammed Alsabri,

Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.

E-mail: alsabri5000@gmail.com


Abstract

Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).

Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.

Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.

Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.

Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability


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How to Cite this article: Kao K, Alsabri M | Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature | July-December 2022; 8(2): 06-12. https://doi.org/10.13107/ti.2022.v08i02.027

 


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The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

Vol 5 | Issue 1 | Jan-April 2019 | page: 10-13  |Muhammad Muzzammil, Muhammad Saeed Minhas, Jahanzeb Effendi, Syed Jahanzeb, Muhammad Ovais, Azeem Jamil, Ayesha Mughal, Abdul Qadir


Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3],   Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2]

1Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
2Department of Orthopedics, Jinnah Post Graduate Medical Centre, Rafiqui Shaheed Road, Karachi.
3Department of surgery, MC 7742, San Antonio.

Address of Correspondence
Dr. Muhammad Muzamil,
Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
Email: muzzammil_sangani@hotmail.com


Abstract

Background: In traumatic patients there is increase loss of blood and requires excessive blood transfusion as compared to other diseases. Clinical efficacy and clinical safety of tranexamic acid in decreasing blood loss assess during this study in post traumatic patients.
Method: Prospectively conducted randomized doubleblind placebo controlled study carried out. Patients were blindly randomized into two groups to receive either intravenous 1gm tranexamic acid 20 min or similar volume of 0.9% saline as placebo (P). Inclusion criteria was based on pulse rate >110 per min or systolic pressure level <90mmHg, hemorrhage or in danger of serious hemorrhage.Patients’ total blood loss was measured, needs of transfusion and hospital stay recorded. The post traumatic hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, platelets count and pulmonary embolism symptoms were comparatively evaluated.
Results: The total measured blood loss in tranexamic acid group (276 ± 53 mL) when comparing to control group (523 ± 74 mL) was less significantly. The requirement of blood transfusion in comparison was high in the control group and post traumatic hematocrit values were higher with in the tranexamic acid group. After administration of tranexamic acid in traumatic patients there have been no clinically relevant differences within the vital signs and no thromboembolic complications were detected in either group.
Conclusion: In traumatic patients, the prophylactic usage of tranexamic acid has effectively decreased blood loss, transfusion needs and hospital stay without any complication or adverse effects of thrombosis. Thus, TXA can be used safely and effectively in trauma subjects.
Keywords: trauma, tranexamic acid, blood loss, transfusion, hospital stay.


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How to Cite this article:  Muzzammil M, Minhas M S, Effendi J, Jahanzeb S, Ovais M, Jamil A, Mughal A, Qadir A. The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan. Trauma International Jan-April 2019;5(1):10-13.

 



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