Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Clinical Trial

Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double‐Blind, Placebo-Controlled Trial

Author(s): Maryam Mousavinejad, Javad Mozafari*, Reza Bahrami Ilkhchi, Mohammad Ghasem Hanafi and Pouya Ebrahimi

Volume 15, Issue 1, 2020

Page: [70 - 75] Pages: 6

DOI: 10.2174/1574887114666191118111826

Price: $65

Abstract

Introduction: Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery.

Methods: This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS).

Results: 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively).

Conclusion: Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

Keywords: Cerebral hemorrhage, emergency medicine, intraparenchymal hemorrhage, tranexamic acid, trauma, linical trial study.

Graphical Abstract

[1]
Khan F, Baguley IJ, Cameron ID. 4: Rehabilitation after traumatic brain injury. Med J Aust 2003; 178(6): 290-5.
[http://dx.doi.org/10.5694/j.1326-5377.2003.tb05199.x] [PMID: 12633489]
[2]
Zehtabchi S, Abdel Baki SG, Falzon L, Nishijima DK. Tranexamic acid for traumatic brain injury: A systematic review and meta-analysis. Am J Emerg Med 2014; 32(12): 1503-9.
[http://dx.doi.org/10.1016/j.ajem.2014.09.023] [PMID: 25447601]
[3]
Thurman DJ. The epidemiology of traumatic brain injury in children and youths: A review of research since 1990. J Child Neurol 2016; 31(1): 20-7.
[http://dx.doi.org/10.1177/0883073814544363] [PMID: 25123531]
[4]
Peden M, Scurfield R, Sleet D, et al. World report on road traffic injury prevention. World Health Organization Geneva 2004.
[5]
Dewan Y, Komolafe EO, Mejía-Mantilla JH, Perel P, Roberts I, Shakur H. CRASH-3 Collaborators.CRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: Study protocol for an international randomized, double-blind, placebo-controlled trial. Trials 2012; 13: 87.
[http://dx.doi.org/10.1186/1745-6215-13-87] [PMID: 22721545]
[6]
Bruns J Jr, Hauser WA. The epidemiology of traumatic brain injury: A review. Epilepsia 2003; 44(s10): 2-10.
[http://dx.doi.org/10.1046/j.1528-1157.44.s10.3.x] [PMID: 14511388]
[7]
Dombovy ML. Traumatic brain injury In: Continuum (Minneapolis,Minn). 2011; 17:: pp. (3 Neurorehabilitation)584-605.
[8]
Hammad A, Westacott L, Zaben M. The role of the complement system in traumatic brain injury: A review. J Neuroinflammation 2018; 15(1): 24.
[http://dx.doi.org/10.1186/s12974-018-1066-z] [PMID: 29357880]
[9]
Bell WN, Alton HG. A brain extract as a substitute for platelet suspensions in the thromboplastin generation test. Nature 1954; 174(4436): 880-1.
[http://dx.doi.org/10.1038/174880a0] [PMID: 13214029]
[10]
D’Agostino E, Hong J, Sudoko C, Simmons N, Lollis SS. Prehospital predictors of emergent intervention after helicopter transfer for spontaneous intraparenchymal hemorrhage. World Neurosurg 2018; 120: e274-81.
[http://dx.doi.org/10.1016/j.wneu.2018.08.050] [PMID: 30142435]
[11]
Benaissa A, Tomas C, Clarençon F, et al. Retrospective analysis of delayed intraparenchymal hemorrhage after flow-diverter treatment: Presentation of a retrospective multicenter trial. AJNR Am J Neuroradiol 2016; 37(3): 475-80.
[http://dx.doi.org/10.3174/ajnr.A4561] [PMID: 26514605]
[12]
Abosadegh MM, Rahman SA, Saddki N. Association of traumatic head injuries and maxillofacial fractures: A retrospective study.Dental traumatology: Official publication of International Association for Dental Traumatology 2017; 33:: 369-74.
[http://dx.doi.org/10.1111/edt.12349]
[13]
Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia 2015; 70: 50-3.
[http://dx.doi.org/10.1111/anae.12910]
[14]
Beno S, Ackery AD, Callum J, Rizoli S. Tranexamic acid in pediatric trauma: Why not? Crit Care 2014; 18(4): 313.
[http://dx.doi.org/10.1186/cc13965] [PMID: 25043066]
[15]
Perper M, Eber AE, Fayne R, et al. Tranexamic acid in the treatment of melasma: A review of the literature. Am J Clin Dermatol 2017; 18(3): 373-81.
[http://dx.doi.org/10.1007/s40257-017-0263-3] [PMID: 28283893]
[16]
Medcalf RL. Fibrinolysis: From blood to the brain. J Thromb Haemost 2017; 15(11): 2089-98.
[http://dx.doi.org/10.1111/jth.13849] [PMID: 28925023]
[17]
McCormack PL. Tranexamic acid: A review of its use in the treatment of hyperfibrinolysis. Drugs 2012; 72(5): 585-617.
[http://dx.doi.org/10.2165/11209070-000000000-00000] [PMID: 22397329]
[18]
Miller JB, Schoenberg MR, Bilder RM. Consolidated Standards of Reporting Trials (CONSORT): Considerations for neuropsychological research. Clin Neuropsychol 2014; 28(4): 575-99.
[http://dx.doi.org/10.1080/13854046.2014.907445] [PMID: 24766549]
[19]
Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141(1): 2-18.
[http://dx.doi.org/10.1037/a0024338] [PMID: 21823805]
[20]
Reilly P, Bullock R. Head Injury 2Ed: Pathophysiology & Management: CRC Press; In: 2005.
[21]
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil 1999; 14(6): 602-15.
[http://dx.doi.org/10.1097/00001199-199912000-00009] [PMID: 10671706]
[22]
Vogel MS. An overview of head trauma for the primary care practitioner, Part I--Etiology, diagnosis, and consequences of head trauma. J Am Optom Assoc 1992; 63(8): 537-41.
[PMID: 1512402]
[23]
Binder LM. A review of mild head trauma. Part II: Clinical implications. J Clin Exp Neuropsychol 1997; 19(3): 432-57.
[http://dx.doi.org/10.1080/01688639708403871] [PMID: 9268817]
[24]
Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006; 148(3): 255-68.
[http://dx.doi.org/10.1007/s00701-005-0651-y] [PMID: 16311842]
[25]
Haar FL. Complication of linear skull fracture in young children. Am J Dis Child 1975; 129(10): 1197-200.
[PMID: 1190143]
[26]
CRASH-2 Collaborators, Intracranial Bleeding Study.Effect of tranexamic acid in traumatic brain injury: A nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ 2011; 343: d3795.
[http://dx.doi.org/10.1136/bmj.d3795] [PMID: 21724564]
[27]
Yutthakasemsunt S, Kittiwatanagul W, Piyavechvirat P, Thinkamrop B, Phuenpathom N, Lumbiganon P. Tranexamic acid for patients with traumatic brain injury: A randomized, double-blinded, placebo-controlled trial. BMC Emerg Med 2013; 13: 20.
[http://dx.doi.org/10.1186/1471-227X-13-20] [PMID: 24267513]
[28]
Cap AP, Baer DG, Orman JA, Aden J, Ryan K, Blackbourne LH. Tranexamic acid for trauma patients: A critical review of the literature. J Trauma 2011; 71(1)(Suppl.): S9-S14.
[http://dx.doi.org/10.1097/TA.0b013e31822114af] [PMID: 21795884]
[29]
Majima N, Nishihara I, Yamaguchi K, Kawakami M. Usefulness of tranexamic acid in patients with severe head injury. Masui Japan J Anesthesiol 2013; 62(4): 410-5.
[30]
Harvey V, Perrone J, Kim P. Does the use of tranexamic acid improve trauma mortality? Ann Emerg Med 2014; 63(4): 460-2.
[http://dx.doi.org/10.1016/j.annemergmed.2013.08.028] [PMID: 24095056]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy