The Impact of Tranexamic Acid on Intracranial Haemorrhage Growth and Mortality Rate Among Patients with Traumatic Brain Injuries.

Abstract

Background: Traumatic Brain Injury (TBI) is a life-threatening injury that has a high mortality and incidence rate worldwide. It is caused by a sudden external force that leads to cerebral dysfunction and multiple complications, most importantly, intracranial haemorrhage (ICH). To treat TBI-induced ICH, tranexamic acid (TXA) has been researched in multiple trials, however, its effect is yet to be determined. Thus, in my review, I aim to evaluate studies in which the impact of TXA was studied to answer whether TXA decrease intracranial haemorrhage growth (IHG) and mortality rate in patients with TBI. Methods: I performed a literature review using a systematic search strategy. The search was conducted in Scopus, Embase, and Medline databases, in October 2023. I focused on English-language randomised controlled trials (RCTs) from 2010 to 2023, that assessed the use of TXA versus placebo or standard care in adult patients with TBI in terms of IHG and mortality rate. I evaluated the studies’ relevance, internal coherence, and comprehensiveness through a critical appraisal strategy. Results: Out of 1804 studies found in the search, 43 were assessed for eligibility. I identified eight RCTs that met the inclusion criteria for this review which used data from over 10,000 patients from various countries. Six studies assessed IHG, and four of them found no significant difference while the other two found a reduction in IHG. In terms of mortality rate, two studies were found, and only one was able to find a mortality rate reduction in a sub-group of patients with TBI. Conclusion: In this dissertation, I concluded from the combined evidence that TXA does not significantly reduce IHG or mortality rates. However, variations in the timing of TXA administration and associations with Glasgow Coma Scale (GCS) scores or severe TBI were identified among the studies, influencing the impact of TXA. To address the knowledge gaps and better guide clinical practice further larger studies are needed.