Impact of Tranexamic Acid on Patient Outcomes in Intracranial Hemorrhage: A Review

Introduction: Intracranial hemorrhage is a medical emergency that remains a significant source of death and disability for patients globally. Tranexamic acid has shown promise in treating trauma related bleeding loss in various settings. This study aims to evaluate its role in the management of intracranial hemorrhages. Methods: A review of data in the PubMed National Library of Medicine was conducted to find relevant and reputable studies related to this topic. Using the search “tranexamic acid AND intracranial hemorrhage*” and the following filters: last 5 years, free full text, English language, including RCTs, meta-analyses, and systematic reviews, 13 results were yielded. After review, 4 articles were selected. Results: Among patients treated within 3 hours of injury, the risk of head injury related death decreased from 19.8% in the placebo group to 18.5% in the TXA group. In addition, the risk of head injury related death was reduced in patients with mild to moderate head injury who received TXA but not in patients with severe head injury. Fewer patients had hematoma expansion in the TXA group than in the placebo group as well as a decreased risk of rebleeding. None of the studies showed a decrease in long term mortality with TXA therapy. Discussion: The data shows that the therapeutic window for TXA is limited to those who present soon after the initial insult and have less severe symptoms. While reduction in hematoma expansion and rebleeding provides a potential role for TXA in the management of ICH, no change in long term mortality ultimately means more studies looking at adjunct or alternative therapies are needed in the future.