title: Haemostatic drugs for traumatic brain injury.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a leading cause of death and disability. Intracranial bleeding is a common complication of TBI, and intracranial bleeding can develop or worsen after hospital admission. Haemostatic drugs may reduce the occurrence or size of intracranial bleeds and consequently lower the morbidity and mortality associated with TBI.
  
  
  OBJECTIVE
  To assess the effects of haemostatic drugs on mortality, disability and thrombotic complications in patients with traumatic brain injury.
  
  
  METHODS
  We searched the electronic databases: Cochrane Injuries Group Specialised Register (3 February 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1950 to Week 3 2009), PubMed (searched 3 February 2009 (last 180 days)), EMBASE (1980 to Week 4 2009), CINAHL (1982 to January 2009), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to January 2009), ISI Web of Science: Conference Proceedings Citation Index - Science (CPCI-S) (1990 to January 2009).
  
  
  METHODS
  We included published and unpublished randomised controlled trials comparing haemostatic drugs (antifibrinolytics: aprotinin, tranexamic acid (TXA), aminocaproic acid or recombined activated factor VIIa (rFVIIa)) with placebo, no treatment, or other treatment in patients with acute traumatic brain injury.
  
  
  METHODS
  Two review authors independently examined all electronic records, and extracted the data. We judged that there was clinical heterogeneity between trials so we did not attempt to pool the results of the included trials. The results are reported separately.
  
  
  RESULTS
  We included two trials. One was a post-hoc analysis of 30 TBI patients from a randomised controlled trial of rFVIIa in blunt trauma patients. The risk ratio for mortality at 30 days was 0.64 (95% CI 0.25 to 1.63) for rFVIIa compared to placebo. This result should be considered with caution as the subgroup analysis was not pre-specified for the trial. The other trial evaluated the effect of rFVIIa in 97 TBI patients with evidence of intracerebral bleeding in a computed tomography (CT) scan. The corresponding risk ratio for mortality at the last follow up was 1.08 (95% CI 0.44 to 2.68). The quality of the reporting of both trials was poor so it was difficult to assess the risk of bias.
  
  
  CONCLUSIONS
  There is no reliable evidence from randomised controlled trials to support the effectiveness of haemostatic drugs in reducing mortality or disability in patients with TBI. New randomised controlled trials assessing the effects of haemostatic drugs in TBI patients should be conducted. These trials should be large enough to detect clinically plausible treatment effects.
authors.affiliation: Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT.
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
authors.forename: Haleema
authors.initials: H
authors.lastname: Shakur
authors.forename: Bandit
authors.initials: B
authors.lastname: Thinkhamrop
authors.forename: Nakornchai
authors.initials: N
authors.lastname: Phuenpathom
authors.forename: Surakrant
authors.initials: S
authors.lastname: Yutthakasemsunt
mesh_terms: D020202:Cerebral Hemorrhage, Traumatic / Q000188:drug therapy*; D015942:Factor VIIa / Q000627:therapeutic use*; D016489:Head Injuries, Closed / Q000150:complications*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa