title: Tranexamic acid for traumatic brain injury: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The antifibrinolytic agent tranexamic acid (TXA) has demonstrated clinical benefit in trauma patients with severe bleeding, but its effectiveness in patients with traumatic brain injury (TBI) is unclear. We conducted a systematic review to evaluate the following research question: In ED patients with or at risk of intracranial hemorrhage (ICH) secondary to TBI, does TXA compared to placebo improve patients' outcomes?
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, and other databases were searched for randomized controlled trial (RCT) or quasi-RCT studies that compared the effect of TXA to placebo on outcomes of TBI patients. The main outcomes of interest included mortality, neurologic function, hematoma expansion, and adverse effects. We used "Grading quality of evidence and strength of recommendations" to assess the quality of trials. Two authors independently abstracted data using a data collection form. Results from studies were pooled when appropriate.
  
  
  RESULTS
  Of 1030 references identified through the search, 2 high-quality RCTs met inclusion criteria. The effect of TXA on mortality had a pooled relative risk of 0.64 (95% confidence interval [CI], 0.41-1.02); on unfavorable functional status, a relative risk of 0.77 (95% CI, 0.59-1.02); and on ICH progression, a relative risk of 0.76 (95% CI, 0.58-0.98). No serious adverse effects (such as thromboembolic events) associated with TXA group were reported in the included trials.
  
  
  CONCLUSIONS
  Pooled results from the 2 RCTs demonstrated statistically significant reduction in ICH progression with TXA and a nonstatistically significant improvement of clinical outcomes in ED patients with TBI. Further evidence is required to support its routine use in patients with TBI.
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY. Electronic address: Shahriar.zehtabchi@downstate.edu.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
authors.affiliation: Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY. Electronic address: samahabdulbaki@gmail.com.
authors.forename: Samah G
authors.initials: SG
authors.lastname: Abdel Baki
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY. Electronic address: af2215@cumc.columbia.edu.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: Department of Emergency Medicine, University of California, Davis, CA. Electronic address: daniel.nishijima@ucdmc.ucdavis.edu.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
mesh_terms: D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid