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Benefits of the tranexamic acid in head trauma with no extracranial bleeding: a prospective follow-up of 180 patients

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Abstract

Introduction

Tranexamic acid (TXA) is one of the debated therapies in the management of traumatic brain injury (TBI). We conducted this study to evaluate the benefits of TXA in TBI on the mortality and its safety in these patients.

Methods

This was a prospective randomized open-label trial including all patients, aged at 18 years or older, hospitalized in the emergency room during a 13-month period, for TBI. After the realization of the body CT scan, the patients were included if they had intracranial bleeding, and were then randomized according to their medical file number to receive or not the TXA. The eligibility criteria were based on the uncertainty principle, patients with significant extracranial bleeding were excluded since there was evidence that TXA improve their outcome.

Results

We enrolled 180 patients aged at 42 ± 20 years, with an 88% men-proportion. Subarachnoid haemorrhage was the most frequent lesion in the brain CT-scan (67.5%). After randomization, 96 patients were in the TXA group (53%). Demographic data, clinical, biological and radiological features were statistically comparable in the two groups of patients (‘TXA’ and ‘noTXA’). The needs of transfusion or neurosurgery, the mortality rate, the in-hospital length of stay and the dependency at 28-post-traumatic day were similar in the two groups of patients. However, pulmonary embolism was statistically more frequent in ‘TXA’ group (11.5 versus 2.4%, p = 0.02).

Conclusion

TXA is an interesting treatment in haemorrhagic shock. Its efficiency in head trauma is still debated and controversial. Its impact on the mortality and the needs of transfusion or surgery were not demonstrated in this study. Nevertheless, its safety worth to be studied in larger samples as we found a higher rate of pulmonary embolism in the treated group.

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Authors and Affiliations

  1. Emergency Department, University Hospital Habib Bourguiba, Service des urgences et SAMU04 SFAX, Route EL Aïn Km 0,5, 3029, Sfax, Tunisia

    Olfa Chakroun-Walha, Amal Samet, Mouna Jerbi, Abdennour Nasri, Aziza Talbi, Hassen Kanoun, Hichem Ksibi & Noureddine Rekik

  2. Radiology Department, University Hospital Habib Bourguiba, Sfax, Tunisia

    Basma Souissi

  3. Intensive Care Unit, University Hospital Habib Bourguiba, Sfax, Tunisia

    Kamilia Chtara & Mounir Bouaziz

Authors
  1. Olfa Chakroun-Walha
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  2. Amal Samet
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Contributions

Study concept and design (OCW, KCH); acquisition of the data (AS, AT, JM, AN, HK, BS); analysis of the data (OCW); drafting of the manuscript (OCW, AS, AN); critical revision of the manuscript (OCW, MB, NR); approval of final manuscript (OCW, NR).

Corresponding author

Correspondence to Olfa Chakroun-Walha.

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Conflict of interest

Olfa Chakroun-Walha, Amal Samet, Mouna Jerbi, Abdennour Nasri, Aziza Talbi, Hassen Kanoun, Basma Souissi, Kamilia Chtara, Mounir Bouaziz, Hichem Ksibi and Noureddine Rekik declare that they have no competing interest.

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Chakroun-Walha, O., Samet, A., Jerbi, M. et al. Benefits of the tranexamic acid in head trauma with no extracranial bleeding: a prospective follow-up of 180 patients. Eur J Trauma Emerg Surg 45, 719–726 (2019). https://doi.org/10.1007/s00068-018-0974-z

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