The Impact of Pre-hospital use of Tranexamic Acid (TXA) in patients with acute Traumatic Brain Injury (TBI)

Abstract

Background: Traumatic brain injury (TBI) is a critical medical condition that has a substantial influence on healthcare systems worldwide. Effective management in pre- hospital settings is essential for enhancing patients outcomes. The efficacy of Tranexamic acid (TXA) in reducing mortality and transfusions in hemorrhagic conditions has been proven. The aim of this systematic review is to assess the effectiveness and safety of TXA administration in the pre-hospital phase of TBI management. The review will specifically examine mortality rates, functional outcomes, and adverse events associated with the use of TXA in TBI patients. Methods: A search was conducted through five electronic databases until May 30, 2023. The study used a search protocol that utilized relevant keywords related to the research question to identify randomized controlled trials, case-control studies, and observational studies published in English since 2018. The studies were focused on assessing the effects of TXA administration in pre-hospital settings for patients with traumatic brain injury. The analysis takes into account specific patient outcomes such as mortality rate, neurological function, and complication risk. Results: Five studies out of 304 were included, involving 7503 participants. One of them was high-quality RCT, and four were retrospective observational studies, three of which were of high quality and one with a high risk of bias. All the included studies reported the primary outcome and showed no mortality benefits, except in one study, which showed an increase in mortality in isolated TBI patients. Secondary outcomes demonstrated no differences in functional outcomes and no further complication risks in TBI patients who received TXA in pre-hospital settings. Conclusion: Most studies reported no difference in the results of the administration of TXA in TBI patients; however, there was a significant difference in mortality with isolated TBI. Further studies need to be done on patients with isolated TBI and different TXA doses. As it is an area where the practice may change.