氨甲环酸在脑外伤患者中的应用:荟萃分析

R.M. Sarhan, M.S. Boshra, M.E.A. Abdelrahim, H. Osama
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引用次数: 0

摘要

背景:我们进行了一项荟萃分析,以评估氨甲环酸对创伤性脑损伤(TBI)患者的有效性和安全性:我们检索了2012年1月至2021年1月期间发表的评估氨甲环酸(TXA)对创伤性脑损伤的有效性和安全性的文献,并确定了8项研究,共计10860名患者:其中 5660 名患者接受了氨甲环酸治疗,5200 名患者作为对照组。我们采用随机或固定效应模型的二分法或连续法评估了TXA在TBI中的疗效和安全性,并计算了平均差(MD)和几率比(OR)以及相应的95%置信区间:在创伤性脑损伤患者中,与对照组相比,早期给予 TXA 有更大的相对益处(MD -2.45;95% CI = -4.78 至 -0.12;p = 0.04),且血肿扩大的程度较小(MD -2.52;95% CI = -4.85 至 -0.19;p = 0.03)。在死亡率(OR 0.94;95% CI = 0.85-1.03;p = 0.18)、进行性出血(OR 0.75;95% CI = 0.56-1.01;p = 0.06)、神经外科手术需求(OR 1.15;95% CI = 0.66-1.98;p = 0.63)、残疾评定量表评分高(OR 0.90;95% CI = 0.56-1.45;p = 0.68)、缺血或血栓栓塞并发症的发生率(OR 1.34;95% CI = 0.33-5.46;p = 0.68):结论:对创伤性脑损伤患者及早使用TXA可能具有更大的相对益处,并可抑制血肿扩大。接受 TXA 治疗的创伤性脑损伤患者与对照组患者在死亡率、进行性出血、神经外科手术需求、高度残疾评定量表评分以及缺血性或血栓栓塞并发症的发生率方面没有明显差异。需要进一步研究来验证这些结果。
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Tranexamic acid in patients with traumatic brain injury: a meta-analysis

Background

We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI).

Methods

We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval.

Results

In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD −2.45; 95% CI = −4.78 to −0.12; p = 0.04) and less total haematoma expansion (MD - 2.52; 95% CI = −4.85 to −0.19; p = 0.03) compared to controls.

There were no statistically significant differences in mortality (OR 0.94; 95% CI = 0.85–1.03; p = 0.18), presence of progressive haemorrhage (OR 0.75; 95% CI = 0.56–1.01; p = 0.06), need for neurosurgery (OR 1.15; 95% CI = 0.66–1.98; p = 0.63), high Disability Rating Scale score (OR 0.90; 95% CI = 0.56–1.45; p = 0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI = 0.33–5.46; p = 0.68) between TBI patients treated with TXA and controls.

Conclusions

Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.

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