The impact of tranexamic acid on brain contusion and intraparenchymal hemorrhage in patients with head injury

Traumatic brain injuries (TBIs) are among leading causes of debility and death at a global scale. The current study aimed at investigating the possible advantage of administrating tranexamic acid (TXA) in patients with post‑TBI brain contusion and intraparenchymal hemorrhage (IPH).

This double‑blind randomized clinical trial was conducted on patients who had brain contusion/IPH according to their on‑admission brain computed tomography (CT) scan, referring to Shahid Beheshti Hospital, Kashan University of Medical Sciences, during 2018-2021. The patients were randomly allocated to either the intervention group (receiving TXA through an antecubital vein access) or the control group (receiving Normal Saline via a similar route). TBI severity, ICH volume, and compressive effects of hemorrhagic mass on admission, 24 h, and 72 h after treatment were assessed. Then 3‑month outcome estimated by Glasgow Outcome Scale (GOS).

There was no significant difference between patients’ age, gender, TBI etiology (traffic collision or fall from height), and skull fracture between the study groups. Compressive effects of hemorrhagic mass, new bleeding and brain edema during 24 and 72 hours after intervention were not significantly different between the TXA and placebo groups. The alterations in ICH volume from preintervention to 24/72 h postintervention were similar between the intervention and placebo subgroups (P > 0.05). Majority of participants (82.5%) showed a good 3‑month neurological outcome according to GOS, but that was not significantly different between the study groups. One case of death occurred in each subgroup, and both of them died after hospital discharge.

TXA neither has a preventive effect against in‑hospital post‑TBI hemorrhage enlargement nor on neurological outcomes three months after hospital discharge.