背景:氨甲环酸(TXA)在创伤性疾病的治疗方法中起着关键作用。然而,其对创伤性脑损伤(TBI)治疗期间降低死亡率和限制颅内出血(ICH)进展的确切影响仍不确定.
方法:PubMed,EMBASE,科克伦图书馆,和WebofScience搜索了截至2023年9月31日在成人TBI中比较TXA和安慰剂的随机对照试验。两位作者独立提取了数据并评估了证据质量。此外,我们进行了亚组分析,以评估低异质性结局.
结果:我们的搜索策略从11项研究中获得了11,299名患者。结果表明,TXA对死亡率没有影响(RR0.93[0.86,1.00],p=0.06;I2:0%,p=0.79),临床结局不佳(RR0.92[0.78,1.09],p=0.34;I2:0%,p=0.40),不良事件(RR0.94[0.83,1.07],p=0.34;I2:48%,p=0.10),血管闭塞事件(RR0.85[0.68,1.06],p=0.16;I2:32%,p=0.22),肺栓塞(RR0.76[0.47,1.22],p=0.26;I2:0%,p=0.83),癫痫发作(RR1.11[0.92,1.35],p=0.27;I2:0%,p=0.49)和出血性并发症(RR0.78[0.55,1.09],p=0.14;I2:0%,p=0.42)。TXA可能降低出血性扩张率(RR0.83[0.70,0.99],p=0.03;I2:18%,p=0.29)和平均出血量(SMD-0.39[-0.60,-0.18],p<0.001;I2:44%,p=0.13)。当从症状发作到治疗的时间间隔<3小时时,TXA减少平均出血量(SMD-0.51[-0.81,-0.20],p=0.001;I2:0%,p=0.94)。
结论:TXA没有增加不良事件的风险,然而,死亡率缺乏降低和临床结局不佳限制了临床应用价值.早期给予TXA(3小时内)可显著降低TBI患者ICH生长的可能性。
BACKGROUND: Tranexamic acid (TXA) holds a pivotal role in the therapeutic approach to traumatic conditions. Nevertheless, its precise influence on diminishing mortality and limiting the progression of intracranial hemorrhage (ICH) during the treatment of traumatic brain injury (TBI) remains indeterminate.
METHODS: PubMed, EMBASE, Cochrane Library, and Web of Science were searched for randomized controlled trials that compared TXA and a placebo in adults with TBI up to September 31, 2023. Two authors independently abstracted the data and assessed the quality of evidence. Additionally, subgroup analyses were performed to assess outcomes with low heterogenety.
RESULTS: Our search strategy yielded 11,299 patients from 11 studies. The result showed that TXA had no effect on mortality (RR 0.93 [0.86, 1.00], p = 0.06; I2: 0%, p = 0.79), poor clinical outcomes (RR 0.92 [0.78, 1.09], p = 0.34; I2: 0%, p = 0.40), adverse events (RR 0.94 [0.83, 1.07], p = 0.34; I2: 48%, p = 0.10), vascular occlusive events (RR 0.85 [0.68, 1.06], p = 0.16; I2: 32%, p = 0.22), pulmonary embolism (RR 0.76 [0.47, 1.22], p = 0.26; I2: 0%, p = 0.83), seizure (RR 1.11 [0.92, 1.35], p = 0.27; I2: 0%, p = 0.49) and hemorrhagic complications (RR 0.78 [0.55, 1.09], p = 0.14; I2: 0%, p = 0.42). TXA might reduce the rate of hemorrhagic expansion (RR 0.83 [0.70, 0.99], p = 0.03; I2: 18%, p = 0.29) and mean hemorrhage volume (SMD -0.39 [-0.60, -0.18], p <0.001; I2: 44%, p = 0.13).When the time interval from symptom onset to treatment was <3 h, TXA reduced mean hemorrhage volume (SMD -0.51 [-0.81, -0.20], p = 0.001; I2: 0%, p = 0.94).
CONCLUSIONS: TXA did not elevate the risk of adverse event, however, the lack of reduction in mortality and the poor clinical outcomes constrain the value of clinical application. Early administration of TXA (within 3 h) may significantly decrease the likelihood of ICH growth in patients with TBI.