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

Document Type : Original Article


1 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Neurosurgery, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

3 Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran



Background and Objectives: 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). Materials and Methods: 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). Results: 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. Conclusion: TXA neither has a preventive effect against in-hospital post-TBI hemorrhage enlargement nor on neurological outcomes three months after hospital discharge.


De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG, Fernandes J, et al. Patient outcome after traumatic brain injury in high-, middle- and low-income countries: Analysis of data on 8927 patients in 46 countries. Int J Epidemiol 2009;38:452-8.  Back to cited text no. 1
Rahimi-Movaghar V, Saadat S, Rasouli MR, Ghahramani M, Eghbali A. The incidence of traumatic brain injury in Tehran, Iran: A population based study. Am Surg 2011;77:e112-4.  Back to cited text no. 2
Perel P, Al-Shahi Salman R, Kawahara T, Morris Z, Prieto-Merino D, Roberts I, et al. CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: The effect of tranexamic acid in traumatic brain injury – A nested randomised, placebo-controlled trial. Health Technol Assess 2012;16:i-54.  Back to cited text no. 3
Roberts I, Yates D, Sandercock P, Farrell B, Wasserberg J, Lomas G, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial. Lancet 2004;364:1321-8.  Back to cited text no. 4
Narayan RK, Maas AI, Servadei F, Skolnick BE, Tillinger MN, Marshall LF, et al. Progression of traumatic intracerebral hemorrhage: A prospective observational study. J Neurotrauma 2008;25:629-39.  Back to cited text no. 5
Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, et al. Progressive hemorrhage after head trauma: Predictors and consequences of the evolving injury. J Neurosurg 2002;96:109-16.  Back to cited text no. 6
Zehtabchi S, Abdel Baki SG, Falzon L, Nishijima DK. Tranexamic acid for traumatic brain injury: A systematic review and meta-analysis. Am J Emerg Med 2014;32:1503-9.  Back to cited text no. 7
Jokar A, Ahmadi K, Salehi T, Sharif-Alhoseini M, Rahimi-Movaghar V. The effect of tranexamic acid in traumatic brain injury: A randomized controlled trial. Chin J Traumatol 2017;20:49-51.  Back to cited text no. 8
CRASH-2 Trial Collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet 2010;376:23-32.  Back to cited text no. 9
Du CN, Liu BX, Ma QF, Yang MF. The effect of tranexamic acid in patients with TBI: A systematic review and meta-analysis of randomized controlled trials. Chin Neurosurg J 2020;6:14.  Back to cited text no. 10
Nelson Yap KB, Albert Wong SH, Idris Z. Tranexamic acid in traumatic brain injury. Med J Malaysia 2020;75:660-5.  Back to cited text no. 11
Samadi-Motlagh P, Shimia M, Shakeri M, Mohammadzadeh A, Salehpour F, Mahdkhah A, et al. Role of tranexamic acid in treatment of patients with epidural hematoma. Iran J Neurosurg 2016;2:8-10.  Back to cited text no. 12
Fakharian E, Abedzadeh-Kalahroudi M, Atoof F. Effect of tranexamic acid on prevention of hemorrhagic mass growth in patients with traumatic brain injury. World Neurosurg 2018;109:e748-53.  Back to cited text no. 13
Mahmood A, Needham K, Shakur-Still H, Harris T, Jamaluddin SF, Davies D, et al. Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: A pre-planned substudy in a sample of CRASH-3 trial patients. Emerg Med J 2021;38:270-8.  Back to cited text no. 14
Yutthakasemsunt S, Kittiwatanagul W, Piyavechvirat P, Thinkamrop B, Phuenpathom N, Lumbiganon P. Tranexamic acid for patients with traumatic brain injury: A randomized, double-blinded, placebo-controlled trial. BMC Emerg Med 2013;13:20.  Back to cited text no. 15
Rowell SE, Meier EN, McKnight B, Kannas D, May S, Sheehan K, et al. Effect of out-of-hospital tranexamic acid versus placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA 2020;324:961-74.  Back to cited text no. 16
Yokobori S, Yatabe T, Kondo Y, Kinoshita K, Japan Resuscitation Council (JRC) Neuroresuscitation Task Force and the Guidelines Editorial Committee. Efficacy and safety of tranexamic acid administration in traumatic brain injury patients: A systematic review and meta-analysis. J Intensive Care 2020;8:46.  Back to cited text no. 17
CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomised, placebo-controlled trial. Lancet 2019;394:1713-23.  Back to cited text no. 18
Roos YB, Rinkel GJ, Vermeulen M, Algra A, van Gijn J. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2003;(2):CD001245.  Back to cited text no. 19
Chakroun-Walha O, Samet A, Jerbi M, Nasri A, Talbi A, Kanoun H, et al. Benefits of the tranexamic acid in head trauma with no extracranial bleeding: A prospective follow-up of 180 patients. Eur J Trauma Emerg Surg 2019;45:719-26.  Back to cited text no. 20