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Quality Checklist for Randomized Clinical Trials: Patients should be treated as soon as possible after injury.вЂќ Secondary Outcomes: Early head injury deaths (Primary Outcome: Head injury-related deaths within 28 days.Intervention: TXA 1g infused over 10 minutes followed by an infusion of another 1g over 8 hours.Excluded: Age less than 16 years of age, extracranial bleeding, or greater than 8 hours since injury (limited to greater than 3 hours from September, 2016).Population: Adult patients 16 years and older with traumatic brain injuries with GCS score of 12 or lower or any intracranial bleed on CT scan and no extracranial bleeding treated within 3 hours of injury.However, there was a statistical reduction in intracranial hematoma expansion size with TXA compared to placebo.Д¬linical Question: Does TXA have mortality benefit in patients with isolated head trauma? The results were no statistical difference in in-hospital mortality or unfavorable neurologic functional status. They found only two high-quality randomized control trials with 510 patients having TBI that met inclusion criteria. Zehtabchi et al published a SRMA of TXA for traumatic brain injuries (TBI). However, better studies are needed to confirm these observations.

Nebulized TXA shows promise for both post-tonsillectomy bleeding and hemoptysis.

It is unclear if it provides a benefit for gastrointestinal bleeds (GIB).

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REBEL EM has also looked at TXA for those conditions plus a few others.

Stroke due to Intracranial Hemorrhage вЂ“ SGEM#236.

It seems to work for epistaxis, fails to cause a decrease in all-cause mortality in post-partum hemorrhage, does not demonstrate an improved neurologic outcome in hemorrhagic strokes but does have 1.5% absolute mortality reduction in adult trauma patients.

The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. You wonder if you should give tranexamic acid (TXA) while you wait for neurosurgery to call you back.Д«ackground: TXA is a synthetic derivative of lysine that inhibits fibrinolysis and thus stabilizing clots that are formed.В We have covered TXA as a treatment for bleeding a number of times on the SGEM. It demonstrates a traumatic intracranial hemorrhage. He is hemodynamically stable and sent for a STAT head CT. He arrives at the emergency department via EMS with a Glasgow Coma Scale (GCS) score of 10 and both pupils reactive.

He is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that tries to cut down knowledge translation gaps of research to bedside clinical practice.Д¬ase : A 42-year-old man falls off a backyard deck. Salim Rezaie currently works as a community emergency physician at Greater San Antonio Emergency Physicians (GSEP), where he is the director of clinical education. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial.