The efficacy of tranexamic acid treatment with different time and doses for traumatic brain injury: a systematic review and meta-analysis

Objective: Tranexamic acid (TXA) has been shown to play a significant role in the treatment of trauma diseases. However, its effectiveness in patients with traumatic brain injury (TBI) seems to be contradictory according to the recent publication of several meta-analyses. We aim to determine the efficacy of TXA treatment with different time and doses for TBI. Methods: : PubMed, MEDLINE, EMBASE, Cochrane library and Google scholar were searched for randomized (RCT) that compared TXA and placebo in adults and adolescents (≥ 15 years of age) with TBI, up to January 31, 2022. Two authors independently abstracted data and assessed the quality of evidence. Results: : Of the identified 673 studies, 13 trials involving 18,675 patients met our inclusion criteria. TXA had no effect on mortality (RR 0.99; 95% CI 0.92–1.06), adverse events (RR 0.93, 95% Cl 0.76-1.14), severe TBI (Glasgow Coma Scale score from 3 to 8) (RR 0.99, 95% Cl 0.94-1.05), unfavorable Glasgow Outcome Scale (GOS <4) (RR 0.96, 95% Cl 0.82-1.11), neurosurgical intervention (RR 1.11, 95%Cl 0.89-1.38), or new bleeding (RR 0.97, 95%Cl 0.82-1.16). TXA might reduce mean hemorrhage volume on subsequent imaging (SMD -0.35; 95% CI [-0.62, -0.08]). Conclusion: TXA at different times and doses was associated with reduced mean bleeding, but not with mortality, adverse events, neurosurgical intervention and new bleeding. We need more research data on different detection indexes and levels of TXA in patients with TBI, as compared to those not receiving TXA although the prognostic outcome for all harm outcomes was no effect, did not rule out the potential for harm. Trial registration The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42022300484).