Recommended Citation
Buch P, McInerney A, Shah A. Assessing Tranexamic Acid Use in Intracranial Hemorrhages Irrespective of Severity. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Tranexamic acid (TXA) is an antifibrinolytic agent commonly used in trauma resuscitation, including in patients with traumatic intracranial hemorrhage (tICH). The CRASH-3 trial demonstrated a mortality benefit when TXA was administered within 3 hours of injury in patients with mild to moderate traumatic brain injury (TBI), measured by a Glasgow Coma Scale (GCS) of 9-15. However, the benefit in patients with severe TBI or those treated beyond the 3-hour window remains unclear. At this institution, TXA may be used outside of CRASH-3 criteria, raising questions about its real-world effectiveness and safety. This study aimed to evaluate TXA utilization and its association with hemostatic effectiveness, mortality, and complications in patients with tICH, regardless of injury severity or timing.
Purpose:
To evaluate the impact of TXA on clinical outcomes in tICH, regardless of injury severity or timing, and to identify potential benefits or limitations of its routine use.
Methods:
This was a retrospective, single-center study of patients who presented to the emergency department with a primary diagnosis of TBI between February 2020 and September 2024. In a 2:1 ratio, patients were selected with two control patients for every patient who received TXA. Patients were then stratified by GCS score and timing of TXA administration. The primary outcome was hemostatic effectiveness based on 24-hour CT scan stability. Secondary outcomes included in-hospital mortality and complications (thromboembolism, myocardial infarction, stroke, seizure). Categorical and continuous variables were analyzed using appropriate statistical tests.
Results:
Ninety-six patients were included (32 TXA, 64 control). Most patients had mild TBI in the TXA and control group (71.9% and 73.4%), and 65.6% of TXA was administered within 3 hours of injury. There was no difference in hemostatic effectiveness between groups, with 24-hour CT showing stability or improvement in 96.7% of TXA patients and 93.5% of the control group, p=0.54. Mortality was higher in the TXA group (15.6% vs. 4.7%, p=0.11). No complications were observed in the TXA group.
Conclusion:
TXA was well tolerated in this tICH population but did not improve hemostatic effectiveness. Higher mortality in the TXA group warrants further investigation. Findings support the need for larger, prospective studies to better define the role of TXA across all severities of tICH and guide appropriate clinical use.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Assessing Tranexamic Acid Use in Intracranial Hemorrhages Irrespective of Severity
Background/Significance:
Tranexamic acid (TXA) is an antifibrinolytic agent commonly used in trauma resuscitation, including in patients with traumatic intracranial hemorrhage (tICH). The CRASH-3 trial demonstrated a mortality benefit when TXA was administered within 3 hours of injury in patients with mild to moderate traumatic brain injury (TBI), measured by a Glasgow Coma Scale (GCS) of 9-15. However, the benefit in patients with severe TBI or those treated beyond the 3-hour window remains unclear. At this institution, TXA may be used outside of CRASH-3 criteria, raising questions about its real-world effectiveness and safety. This study aimed to evaluate TXA utilization and its association with hemostatic effectiveness, mortality, and complications in patients with tICH, regardless of injury severity or timing.
Purpose:
To evaluate the impact of TXA on clinical outcomes in tICH, regardless of injury severity or timing, and to identify potential benefits or limitations of its routine use.
Methods:
This was a retrospective, single-center study of patients who presented to the emergency department with a primary diagnosis of TBI between February 2020 and September 2024. In a 2:1 ratio, patients were selected with two control patients for every patient who received TXA. Patients were then stratified by GCS score and timing of TXA administration. The primary outcome was hemostatic effectiveness based on 24-hour CT scan stability. Secondary outcomes included in-hospital mortality and complications (thromboembolism, myocardial infarction, stroke, seizure). Categorical and continuous variables were analyzed using appropriate statistical tests.
Results:
Ninety-six patients were included (32 TXA, 64 control). Most patients had mild TBI in the TXA and control group (71.9% and 73.4%), and 65.6% of TXA was administered within 3 hours of injury. There was no difference in hemostatic effectiveness between groups, with 24-hour CT showing stability or improvement in 96.7% of TXA patients and 93.5% of the control group, p=0.54. Mortality was higher in the TXA group (15.6% vs. 4.7%, p=0.11). No complications were observed in the TXA group.
Conclusion:
TXA was well tolerated in this tICH population but did not improve hemostatic effectiveness. Higher mortality in the TXA group warrants further investigation. Findings support the need for larger, prospective studies to better define the role of TXA across all severities of tICH and guide appropriate clinical use.
Affiliations
Advocate Lutheran General Hospital