The efficacy of tranexamic acid for brain injury: A meta-analysis of randomized controlled trials

Abstract Background Tranexamic acid shows some treatment efficacy for traumatic brain injury. This systematic review and meta-analysis is conducted to investigate the efficacy of tranexamic acid for traumatic brain injury. Methods The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials (RCTs) regarding the efficacy of tranexamic acid for traumatic brain injury. Results This meta-analysis has included six RCTs. Compared with placebo group in patients with traumatic brain injury, tranexamic acid results in remarkably reduced mortality (risk ratio (RR) = 0.91; 95% confidence interval (CI) = 0.85 to 0.97; P = 0.004) and growth of hemorrhagic mass (RR = 0.78; 95% CI = 0.61 to 0.99; P = 0.04), but has no important impact on neurosurgery (RR = 0.99; 95% CI = 0.85 to 1.15; P = 0.92), extracranial surgery (RR = 1.00; 95% CI = 0.97 to 1.04; P = 0.99), unfavorable outcome (Glasgow Outcome Scale, GOS) (RR = 0.72; 95% CI = 0.47–1.11; P = 0.14), pulmonary embolism (RR = 1.86; 95% CI = 0.42–8.29; P = 0.42), and deep venous thrombosis (RR = 0.97; 95% CI = 0.64–1.47; P = 0.88). Conclusions Tranexamic acid is associated with substantially reduced mortality and growth of hemorrhagic mass in patients with traumatic brain injury, but the need of neurosurgery and extracranial surgery, as well as the risk of unfavorable outcome (GOS) are similar between tranexamic acid and placebo.