Improving survival with tranexamic acid in cerebral contusions or traumatic subarachnoid hemorrhage: univariate and multivariate analysis on independent factors associated with lower mortality

Abstract

Background: Fall with head injury is an epidemic challenge especially with the aging population. Contributing factors for mortality included the development of cerebral contusions and delayed traumatic intracerebral hematoma. Currently, there is no established treatment for these conditions.

Object: This study aimed to investigate the impact of independent factors on the mortality rate of traumatic brain injury with contusions or traumatic subarachnoid hemorrhage.

Methods: Data were collected from consecutive patients admitted for cerebral contusions or traumatic subarachnoid hemorrhage at an academic trauma center from 2010-2016. The primary outcome was 30-day mortality rate. Independent factors for analysis included patients’ factors and treatment modalities. Univariate and multivariate analysis were conducted to identify independent factors related to mortality. Secondary outcomes including thrombo-embolic complication rates associated with the use of tranexamic acid.

Results: In total 651 consecutive patients were identified. For the patients’ factors, low Glasgow Coma Scale on admission, history of renal impairment and use of warfarin were identified as independent factors associated with higher mortality from univariate and multivariate analysis. For the treatment modalities, univariate analysis identified tranexamic acid as an independent factor associated with lower mortality (p=0.021). Thromboembolic events were comparable in patients with or without tranexamic acid.

Conclusion: Tranexamic acid was identified as an independent factor associated with lower mortality from univariate analysis in cerebral contusions or traumatic subarachnoid hemorrhage. Further prospective studies are needed to validate this finding.