Tranexamic acid for traumatic brain injury? Old drug raises new debate

Abstract

Traumatic brain injury (TBI) is one of the leading causes of death and disability in children and young adults, but also an important medical problem concerning the older part of the population. TBI has an inauspicious prognosis and the mortality remains high, reaching up to 40% in severe injuries. Extensive research on treatment options that could minimize the mortality rate and the number of complications is ongoing and one of these options is tranexamic acid. One of the pathomechanisms of uncontrollable bleeding is hyperfibrinolysis, where the mechanisms controlling fibrinolysis are disrupted and cause it to become excessively intensified. Tranexamic acid (TXA) is an inhibitor of plasminogen and thus inhibits fibrinolysis. This paper aims to provide an overview of the current state of knowledge about tranexamic acid in traumatic brain injury. According to available, data pre-hospital intravenous tranexamic acid infusion administered early, within 3 hours from the injury, seems to reduce mortality in patients with mild to moderate traumatic brain injury, but in patients with severe TBI, this treatment could be associated with increased mortality. The use of TXA does not increase the risk of adverse events. Moreover, the safety of tranexamic acid has been confirmed and no correlation between the use of TXA and a higher incidence of thromboembolic events has been found. Current findings do not give a conclusive answer on the effectiveness of TXA in TBI. Large, international randomized clinical trials have to be performed to answer this question. Additionally, further studies in the use of TXA in TBI in the pediatric population are also needed.