R.E.B.E.L.EM - October 15, 2019 - By Salim Rezaie
"Author Conclusion: “Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.”
Clinical Take Home Point: The overall effect size of TXA on ICH is not that impressive based on this trial and also not statistically significant. It is possible that the effect of TXA on head injury-related death is dependent on the time interval between injury and the severity of the TBI. However, this is a select group of patients defined as:
- Early treatment (<3hrs)
- Mild to moderate (GCS 9 – 15)
- ICH on baseline head CT.
These patients potentially have the highest mortality benefit, and it would be reasonable to give TXA, but, would not consider it standard practice at this point in time based on the best available evidence. Given there were minimal adverse events, it would be wrong to conclude that TXA in ICH is ineffective as there are patients who may improve with this therapy, however with wide confidence intervals, it is difficult to make definitive conclusions when looking at these subpopulations."