Thread by @SameerSharifMD

Extremely proud of @Kumait_Allawati for co-leading this great project examining the use of TXA in TBI. This was a massive collaboration between @MacEmerg @EMUofT @MacCriticalCare. Not one iota of this would be possible without the amazing mentorship & support of @Bram_Rochwerg /1

This UpToDate systematic review and meta-analysis includes the Rowell study published in JAMA 6 weeks ago! We also acquired the mortality data from the CRASH-3 authors so as not to compare head-injury related death. Our manuscript can be found here: link.springer.com/article/10.100… /2

What did we find? TXA probably has no effect on mortality (RR 0.95; 95% CI 0.88 to 1.02) or disability (RR 0.90; 95% CI 0.69 to 1.17) /3

What about using TXA in low to middle income countries? Our post-hoc subgroup analysis did not show a benefit with the use of TXA in high income versus low to middle income countries /4

What about giving TXA early within 3 hours? It is possible that TXA could be more efficacious in those that receive the drug earlier or in those with differing severity of TBI; however, this analysis is not able to address these questions /5

Overall, these results do not support strong directives re: TXA in TBI. Some may rationalize not giving TXA to patients given the costs & lack of clear benefit, while others may choose to administer TXA given the lack of demonstrable harm & potential reduction in hematoma size /6

We hope this systematic review & meta-analysis will be of use to frontline clinicians and future guideline working groups 7/7
@yourICM @MacDeptMed @McMasterSurgery @emergmedottawa @TBIConference @MacCEprog @CCCForum @brain_trauma

As an aside, it's really nice to see so many @MacEmerg co-authors on the same manuscript!! @Kumait_Allawati @DrSaidAlMaqbali @HusseinRimawi @doquinlan @JulianOwenEM_CC