Several results have been reported on the efficacy of tranexamic acid (TXA) in patients with acute traumatic brain injury (TBI). As such, Lawati et al. (2020[4]) conducted a meta-analysis to determine the safety and efficacy of TXA in these patients. The authors summarized nine randomized controlled trials (RCT), which resulted in a pooled relative risk (RR) (95% confidence interval [CI]) of TXA of 0.95 (0.88-1.02) for mortality. There was also no significant difference in disability assessed using the Disability Rating Scale. Furthermore, the pooled RR (95% CI) of TXA for hematoma expansion was 0.77 (0.58-1.03). Although the use of TXA did not increase the risk of adverse events, no advantages were observed for using TXA in TBI patients.Rowell et al. (2020[5]) conducted a double-blinded RCT to determine whether TXA treatment initiated in the out-of-hospital setting within 2 hours of injury improved neurologic outcome in patients with moderate or severe TBI. Similarly, TXA administration did not improve the 6-month neurologic outcome as measured using the Glasgow Outcome Scale-Extended. Cone et al. (2020[1]) also commented that a large trial assessing efficacy with optimized dosing protocols, a mortality end point, and specific focus on the TBI severity cohorts should be conducted to verify the existence of benefits.In contrast, an RCT report presented that the adjusted RRs (95% CIs) of TXA for mild-to-moderate and severe TBI death were 0.78 (0.64-0.95) and 0.99 (0.91-1.07), respectively (CRASH-3 trial collaborators, 2019[2]). In addition, early treatment was more effective than later treatment in patients with mild-to-moderate head injury that could result in death. This means that the level of severity in patients with TBI is important for subsequent clinical interventions.There is a comment regarding the inconsistent results (Kawada, 2020[3]), and a meta-analysis of RCTs ensuring high-quality of each trial should be conducted with special reference to the level of severity.
Authors: Kumait Al Lawati; Sameer Sharif; Said Al Maqbali; Hussein Al Rimawi; Andrew Petrosoniak; Emilie P Belley-Cote; Sunjay V Sharma; Justin Morgenstern; Shannon M Fernando; Julian J Owen; Michelle Zeller; David Quinlan; Waleed Alhazzani; Bram Rochwerg Journal: Intensive Care Med Date: 2020-10-20 Impact factor: 17.440
Authors: Susan E Rowell; Eric N Meier; Barbara McKnight; Delores Kannas; Susanne May; Kellie Sheehan; Eileen M Bulger; Ahamed H Idris; Jim Christenson; Laurie J Morrison; Ralph J Frascone; Patrick L Bosarge; M Riccardo Colella; Jay Johannigman; Bryan A Cotton; Jeannie Callum; Jason McMullan; David J Dries; Brian Tibbs; Neal J Richmond; Myron L Weisfeldt; John M Tallon; John S Garrett; Martin D Zielinski; Tom P Aufderheide; Rajesh R Gandhi; Rob Schlamp; Bryce R H Robinson; Jonathan Jui; Lauren Klein; Sandro Rizoli; Mark Gamber; Michael Fleming; Jun Hwang; Laura E Vincent; Carolyn Williams; Audrey Hendrickson; Robert Simonson; Patricia Klotz; George Sopko; William Witham; Michael Ferrara; Martin A Schreiber Journal: JAMA Date: 2020-09-08 Impact factor: 56.272