Outcomes of Tranexamic Acid in Patients with Traumatic Brain Injury: A Meta-analysis of 36,692 Patients

Background We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI). Methods We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval. Results In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD −2.45; 95% CI = −4.78 to −0.12; p=0.04) and less total haematoma expansion (MD - 2.52; 95% CI = −4.85 to −0.19; p=0.03) compared to controls.There were no statistically significant differences in mortality (OR 0.94; 95% CI=0.85–1.03; p=0.18), presence of progressive haemorrhage (OR 0.75; 95% CI=0.56–1.01; p=0.06), need for neurosurgery (OR 1.15; 95% CI=0.66–1.98; p=0.63), high Disability Rating Scale score (OR 0.90; 95% CI=0.56–1.45; p=0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI=0.33–5.46; p=0.68) between TBI patients treated with TXA and controls. Conclusions Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.