Safety and efficacy of tranexamic acid and beta-blockers for traumatic brain injury: A systematical review and meta-analysis.

BACKGROUND

Intracranial hemorrhage is a leading cause of secondary brain injury following traumatic brain injury (TBI). Tranexamic acid (TXA), an antifibrinolytic agent, is recommended by Advanced Trauma Life Support for hemorrhagic trauma, but its role in TBI remains debated. Recent meta-analyses and randomized controlled trials (RCTs) have demonstrated conflicting results regarding TXA's mortality benefits, while beta-blockers (BBs) show potential in mitigating hyperadrenergic states post-TBI. This study aims to update the evidence on TXA and BB administration in TBI by incorporating newer RCTs and systematic reviews published post-February 2023.

METHODS

A systematic search of PubMed, ScienceDirect, and clinicaltrials.gov was conducted using keywords: "tranexamic acid," "beta blockers," and "traumatic brain injury." Studies published up to December 2024 were included to address gaps in the literature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and data were analyzed using RevMan 5. Primary outcomes were the safety and efficacy of TXA and BB.

RESULTS

Thirteen RCTs (n = 16,452) were included, expanding on prior meta-analyses. TXA did not significantly reduce mortality (relative risk 0.93, 95% confidence intervals [CI] 0.86-1.01) but reduced hematoma progression (mean difference -3.67 cm3,*P* = 0.007). BB showed a non-significant mortality reduction (13.65% vs. 18.34%; Odds ratio [OR] 0.55 [95% CI 0.27-1.13]). Adverse events were comparable between groups.

CONCLUSION

TXA and BB are safe but do not significantly improve mortality in TBI. Our updated analysis aligns with recent literature, underscoring the need for further RCTs to clarify subgroups (e.g., mild-moderate TBI) that may benefit.