Early tranexamic acid in traumatic brain injury: Evidence for an effective therapy.

The guidelines for management of traumatic brain injury (TBI) are based largely on measures to maintain an optimum internal milieu for prevention of secondary brain injury and enhancing recovery. One of the most common reasons for worsening outcomes following TBI is expanding intracranial haematoma which is compounded by the fibrinolytic physiology that follows TBI. Tranexamic acid (TXA) has a time tested role in preventing poor outcomes linked to excessive haemorrhage in trauma patients. Historically, patients with isolated head trauma were excluded from TXA use due to a theoretical increased risk of thrombosis. Recent evidence that redefines the beneficial role of early TXA administration in preventing mortality amongst patients with TBI is now at hand and offers a real prospect of a pharmacological intervention that would be adopted as a recommendation based on Class l evidence.

Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial.

INTRODUCTION: Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. METHODS: This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). RESULTS: 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). CONCLUSION: Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

Accident analysis to support the development of strategies for the prevention of brain injuries in car crashes.

This study estimated the frequency and risk of Moderate-to-Maximal traumatic brain injuries sustained by occupants in motor vehicle crashes in the US. National Automotive Sampling System - Crashworthiness Data System crashes that occurred in years 2001-2015 with light vehicles produced 2001 or later were incorporated in the study. Crash type, crash severity, car model year, belt usage and occupant age and sex were controlled for in the analysis. The results showed that Moderate concussions account for 79% of all MAISbrain2+ injuries. Belted occupants were at lower risks than unbelted occupants for most brain injury categories, including concussions. After controlling for the effects of age and crash severity, belted female occupants involved in frontal crashes were estimated to be 1.5 times more likely to sustain a concussion than male occupants in similar conditions. Belted elderly occupants were found to be at 10.5 and 8 times higher risks for sub-dural haemorrhages than non-elderly belted occupants in frontal and side crashes, respectively. Adopted occupant protection strategies appear to be insufficient to achieve significant decreases in risk of both life-threatening brain injuries and concussions for all car occupants. Further effort to develop occupant and injury specific strategies for the prevention of brain injuries are needed. This study suggests that these strategies may consider prioritization of life-threatening brain vasculature injuries, particularly in elderly occupants, and concussion injuries, particularly in female occupants.

Neonatal outcomes with different betamethasone dosing regimens: a comparison.

OBJECTIVE: To determine any differences in neonatal outcomes when dosing betamethasone every 12 hours vs. 24 hoursfor anticipated preterm delivery. STUDY DESIGN: A retrospective review of births at <36 weeks' gestation from January 1, 1996, to July 1, January 1, 1996, to July 1, 2000. Maternal and neonatal charts were reviewed. The deliveries were separated into 3 groups: those not receiving antenatal corticosteroids, those who received betamethasone 12 hours apart and those who received 24-hour dosing. Demographic, obstetric and neonatal variables were compared between the groups. RESULTS: There were 909 deliveries analyzed. With the 2 betamethasone groups, a significant difference was found for more maternal antibiotic use (90.4% vs. 83.6%, p=0.03), venous cord blood gas pH (7.31 vs. 7.32, p=0.04) and neonatal surfactant use (39.8% vs. 25.5%, p = 0.001) in the 12-hour group as compared to the 24-hour group. For all other outcomes there was no difference. CONCLUSION: Outcomes using a 12-hour dosing schedule of betamethasone were similar to those using a 24-hour regimen in this retrospective review. Twelvehour dosing could be considered an alternative way to deliver antenatal corticosteroids.