Prehospital Tranexamic Acid Increases Mortality Risk in Isolated Severe TBI

Young man with trauma of the head
In patients with isolated severe traumatic brain injury, prehospital treatment with tranexamic acid may increase the risk mortality.

In patients with isolated severe traumatic brain injury (TBI), prehospital treatment with tranexamic acid may increase the risk mortality, according to study results published in JAMA Neurology.

Severe TBI is a major cause of trauma-related mortality and disability. Study researchers sought to determine whether prehospital administration of tranexamic acid is related to mortality and functional outcomes in patients with TBI.

This study was a retrospective analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study, which was conducted in the Netherlands. The study researchers analyzed data for patients treated for suspected severe TBI between 2012 and 2017. They followed patients and collected in-hospital and outcome data up to 1 year after inclusion.

Study researchers analyzed the association between prehospital treatment with tranexamic acid and 30-day mortality. In addition, they assessed 1-year mortality, functional neurological recovery at discharge as assessed by the Glasgow Outcome Scale, and the length of hospital stay.

In total, 1827 patients treated for suspected TBI were included in this analysis (median age, 45 years; men, 70%). A significantly higher 30-day mortality was found in the adjusted analysis of patients treated with prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P <.001) compared with patients not treated with tranexamic acid prior to hospital admission. This association held true in sub-analyses of patients with confirmed TBI (OR, 1.34; 95% CI, 1.15-1.56; P <.001) and in patients with isolated TBI (OR, 1.74; 95% CI, 1.33-2.27; P <.001).

In the analysis adjusted for potential confounders, there was no association between prehospital tranexamic acid treatment and mortality TBI in the full study cohort and in patients with confirmed TBI, but there was an increase in the odds of 30-day mortality in patients with isolated severe TBI treated with prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P =.005). This association persisted after multiple imputations but was not as pronounced (OR, 2.05; 95% CI, 1.22-3.45; P =.007).

Limitations of the study included the lack of analysis on the causal link between prehospital tranexamic acid use and mortality, as well as the possible residual confounding variables not adjusted for in the final analyses.

The researchers ultimately concluded that their study findings “[suggest] that administration of tranexamic acid should be avoided” in patients with isolated severe TBI.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Bossers SM, Loer SA, Bloemers FW, et al. Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol. Published online December 7, 2020. doi:10.1001/jamaneurol.2020.4596