Prehospital Administration of Tranexamic Acid Could Increase Mortality in Severe Isolated TBIs

Prehospital administration of tranexamic acid was associated with increased mortality in patients with isolated severe traumatic brain injuries (TBIs), according to new findings published in JAMA Neurology (2021 Mar; 78(3):338-345).

The development and expansion of intracranial hematoma are associated with adverse outcomes,” wrote Sebastiaan M. Mossers, MD, Amsterdam University Medical Center, Netherlands and colleagues, explaining the use of tranexamic acid may limit intracranial hematoma formation but its association with severe TBIs remains unclear.

Researchers sought to determine the association between prehospital tranexamic acid administration and outcomes of patients with severe traumatic brain injury in this multicenter cohort study analyzing data from the BRAIN-PROTECT study in the Netherlands.

A total of 1827 patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included in the analysis.

The primary endpoint was 30-day mortality. Secondary endpoints included mortality at 1 year, functional neurological recovery at discharge, and length of hospital stay.

Higher 30-day mortality was observed in the unadjusted analysis in patients who received prehospital tranexamic acid (odds ratio, 1.34; 95% CI, 1.16-1.55; P < .001) compared with patients who did not receive prehospital tranexamic acid. After an adjusted analysis, no association between prehospital administration of tranexamic acid was found across the entire cohort of patients.

Notably, a substantial increase in the odds of 30-day mortality was observed in a subset of patients with severe isolated TBI who received prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P = .005) and after multiple imputations (OR, 2.05; 95% CI, 1.22-3.45; P = .007).

Dr Mossers et al concluded “prehospital tranexamic acid administration was associated with increased mortality in patients with isolated severe TBI, suggesting the judicious use of the drug when no evidence for extracranial hemorrhage is present.”—Kaitlyn Manasterski