The American journal of emergency medicine · 2025
Efficacy of tranexamic acid in adult isolated traumatic brain injury: A multicenter retrospective study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Utsumi Shu, Ohki Shingo, Shime Nobuaki
Аннотация
OBJECTIVES: To evaluate the association between tranexamic acid (TXA) and neurological outcome, including mortality, in isolated traumatic brain injury (TBI), considering the severity of TBI.
METHODS: This multicenter, retrospective, cross-sectional study was conducted using Japan Trauma Data Bank from 2019 to 2023. Patients aged ≥18 years with TBI not complicated by extracranial injury who underwent computed tomography imaging within 3 h of injury were included. The primary outcome was in-hospital mortality and the secondary outcome was poor neurological outcome at hospital discharge, defined as a Glasgow Outcome Scale score of 1-3. The association between TXA administration and clinical outcomes was assessed using logistic regression adjusted by propensity score-based inverse probability of treatment weighting (IPTW). TBI severity was classified using the Glasgow Coma Scale scores as severe (3-8), moderate (9-12), or mild (13-15) to further evaluate the outcomes.
RESULTS: During the study period, 5732 patients were included, and the main analysis was conducted on 5639 patients excluding those with missing valiables. After IPTW, TXA was not associated with in-hospital mortality (adjusted odds ratio [aOR], 0.82; 95 % confidence interval [CI], 0.66-1.01) nor poor neurological outcome (aOR, 1.01; 95 % CI, 0.79-1.30). In the subgroup analysis according to TBI severity, in-hospital mortality was significantly lower in the TXA group only in patients with severe TBI (aOR, 0.78; 95 % CI, 0.63-0.97).
CONCLUSIONS: Our study found that TXA is associated with reduced mortality only in patients with isolated severe TBI.
METHODS: This multicenter, retrospective, cross-sectional study was conducted using Japan Trauma Data Bank from 2019 to 2023. Patients aged ≥18 years with TBI not complicated by extracranial injury who underwent computed tomography imaging within 3 h of injury were included. The primary outcome was in-hospital mortality and the secondary outcome was poor neurological outcome at hospital discharge, defined as a Glasgow Outcome Scale score of 1-3. The association between TXA administration and clinical outcomes was assessed using logistic regression adjusted by propensity score-based inverse probability of treatment weighting (IPTW). TBI severity was classified using the Glasgow Coma Scale scores as severe (3-8), moderate (9-12), or mild (13-15) to further evaluate the outcomes.
RESULTS: During the study period, 5732 patients were included, and the main analysis was conducted on 5639 patients excluding those with missing valiables. After IPTW, TXA was not associated with in-hospital mortality (adjusted odds ratio [aOR], 0.82; 95 % confidence interval [CI], 0.66-1.01) nor poor neurological outcome (aOR, 1.01; 95 % CI, 0.79-1.30). In the subgroup analysis according to TBI severity, in-hospital mortality was significantly lower in the TXA group only in patients with severe TBI (aOR, 0.78; 95 % CI, 0.63-0.97).
CONCLUSIONS: Our study found that TXA is associated with reduced mortality only in patients with isolated severe TBI.