Mortality Benefit of Tranexamic Acid for Hemorrhage With Concurrent Traumatic Brain Injury: Outcomes From a Prospective Cohort Study in a High-Trauma, Prolonged Care Setting.

BACKGROUND: Traumatic brain injury (TBI) and hemorrhage are leading causes of trauma death and disability worldwide. The concurrence of hemorrhage and brain injury carries a two-fold increase in mortality and clinical management of patients with concurrent TBI and hemorrhage is challenging. Tranexamic acid (TXA) has been shown to reduce mortality from hemorrhage and TBI independently, however there is sparse evidence on the potential benefit of TXA in patients with both non-head hemorrhage and TBI. METHODS: We conducted a secondary database analysis of EpiC, a multicenter, prospective cohort of trauma patients in South Africa. We compared the morbidity and mortality of patients experiencing both non-head hemorrhage and TBI who received TXA within 3-h post-injury versus similarly injured patients who did not receive TXA. Inverse probability treatment weighting (IPTW) was implemented followed by a multivariable logistic regression to evaluate 7-day mortality. Secondary outcomes included the worst 7-day sequential organ failure assessment (SOFA) and neurologic recovery assessed by Glasgow Outcomes Score Extended (GOSE). RESULTS: A total of 656 patients were included in the analysis. 132 (20%) received TXA within 3 h and 544 (80%) did not. For the primary outcome of 7-day mortality, treatment with TXA was associated with a 22% reduction in odds of death (mOR, 0.78, 95% CI, 0.62-0.98). TXA-treated patients had significant lower odds of SOFA > 4 or death (mOR, 0.71; 95%CI, 0.53-0.95) and non-significantly reduced odds of poor functional status at 3 months (GOSE < 7 or death) (mOR, 0.89; 95% CI, 0.68-1.18). Treatment with TXA within 2 h was associated with a 27% reduction in odds of 7-day mortality (mOR, 0.73; 95%CI, 0.61-0.86). CONCLUSIONS: In this study, the administration of TXA within 3 h to patients with concurrent hemorrhage and TBI was associated with a 22% reduction in mortality at 7 days. The mortality benefit was slightly larger when TXA was given within 2 h. TXA treatment was also associated with lower risk of organ failure. These results support a growing body of evidence that TXA is an effective intervention to reduce mortality and morbidity after traumatic injury.