TY - JOUR
T1 - Efficacy and safety of tranexamic acid administration in traumatic brain injury patients
T2 - A systematic review and meta-analysis
AU - Yokobori, Shoji
AU - Yatabe, Tomoaki
AU - Kondo, Yutaka
AU - Kinoshita, Kosaku
AU - Ajimi, Yasuhiko
AU - Iwase, Masaaki
AU - Unemoto, Kyoko
AU - Kumasawa, Junji
AU - Goto, Jun
AU - Kobata, Hitoshi
AU - Sawamura, Atsushi
AU - Hifumi, Toru
AU - Hoshiyama, Eisei
AU - Honda, Mitsuru
AU - Norisue, Yasuhiro
AU - Matsumoto, Shoji
AU - Miyake, Yasufumi
AU - Moriya, Takashi
AU - Yasuda, Hideto
AU - Yamakawa, Kazuma
AU - Yang, Sunghoon
AU - Wakasugi, Masahiro
AU - Nagayama, Masao
AU - Nonogi, Hiroshi
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/3
Y1 - 2020/7/3
N2 - Background: The exacerbation of intracranial bleeding is critical in traumatic brain injury (TBI) patients. Tranexamic acid (TXA) has been used to improve outcomes in TBI patient. However, the effectiveness of TXA treatment remains unclear. This study aimed to assess the effect of administration of TXA on clinical outcomes in patients with TBI by systematically reviewing the literature and synthesizing evidence of randomized controlled trials (RCTs). Methods: MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (ICHUSHI) Web were searched. Selection criteria included randomized controlled trials with clinical outcomes of adult TBI patients administered TXA or placebo within 24 h after admission. Two investigators independently screened citations and conducted data extraction. The primary "critical"outcome was all-cause mortality. The secondary "important"outcomes were good neurological outcome rates, enlargement of bleeding, incidence of ischemia, and hemorrhagic intracranial complications. Random effect estimators with weights calculated by the inverse variance method were used to report risk ratios (RRs). Results: A total of 640 records were screened. Seven studies were included for quantitative analysis. Of 10,044 patients from seven of the included studies, 5076 were randomly assigned to the TXA treatment group, and 4968 were assigned to placebo. In the TXA treatment group, 914 patients (18.0%) died, while 961 patients (19.3%) died in the placebo group. There was no significant difference between groups (RR, 0.93; 95% confidence interval, 0.86-1.01). No significant differences between the groups in other important outcomes were also observed. Conclusions: TXA treatment demonstrated a tendency to reduce head trauma-related deaths in the TBI population, with no significant incidence of thromboembolic events. TXA treatment may therefore be suggested in the initial TBI care.
AB - Background: The exacerbation of intracranial bleeding is critical in traumatic brain injury (TBI) patients. Tranexamic acid (TXA) has been used to improve outcomes in TBI patient. However, the effectiveness of TXA treatment remains unclear. This study aimed to assess the effect of administration of TXA on clinical outcomes in patients with TBI by systematically reviewing the literature and synthesizing evidence of randomized controlled trials (RCTs). Methods: MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (ICHUSHI) Web were searched. Selection criteria included randomized controlled trials with clinical outcomes of adult TBI patients administered TXA or placebo within 24 h after admission. Two investigators independently screened citations and conducted data extraction. The primary "critical"outcome was all-cause mortality. The secondary "important"outcomes were good neurological outcome rates, enlargement of bleeding, incidence of ischemia, and hemorrhagic intracranial complications. Random effect estimators with weights calculated by the inverse variance method were used to report risk ratios (RRs). Results: A total of 640 records were screened. Seven studies were included for quantitative analysis. Of 10,044 patients from seven of the included studies, 5076 were randomly assigned to the TXA treatment group, and 4968 were assigned to placebo. In the TXA treatment group, 914 patients (18.0%) died, while 961 patients (19.3%) died in the placebo group. There was no significant difference between groups (RR, 0.93; 95% confidence interval, 0.86-1.01). No significant differences between the groups in other important outcomes were also observed. Conclusions: TXA treatment demonstrated a tendency to reduce head trauma-related deaths in the TBI population, with no significant incidence of thromboembolic events. TXA treatment may therefore be suggested in the initial TBI care.
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U2 - 10.1186/s40560-020-00460-5
DO - 10.1186/s40560-020-00460-5
M3 - Review article
AN - SCOPUS:85089984561
SN - 2052-0492
VL - 8
JO - Journal of Intensive Care
JF - Journal of Intensive Care
IS - 1
M1 - 46
ER -