Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis of Independent Factors Associated with Lower Mortality

World Neurosurg. 2019 May;125:e665-e670. doi: 10.1016/j.wneu.2019.01.145. Epub 2019 Feb 2.


Background: Fall with head injury is a pervasive challenge, especially in the aging population. Contributing factors for mortality include the development of cerebral contusions and delayed traumatic intracerebral hematoma. Currently, there is no established specific 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 to 2016. The primary outcome was the 30-day mortality rate. Independent factors for analysis included patient factors and treatment modalities. Univariate and multivariate analyses were conducted to identify independent factors related to mortality. Secondary outcomes included thromboembolic complication rates associated with the use of tranexamic acid.

Results: In total, 651 consecutive patients were identified. For the patient 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 analyses. 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 by univariate analysis as an independent factor associated with lower mortality in cerebral contusions or traumatic subarachnoid hemorrhage. Further prospective studies are needed to validate this finding.

Keywords: Cerebral contusion; Subarachnoid hemorrhage; Tranexamic acid; Traumatic brain injury; Traumatic subarachnoid hemorrhage.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Contusion / drug therapy*
  • Brain Contusion / mortality*
  • Cerebral Hemorrhage, Traumatic / drug therapy
  • Cerebral Hemorrhage, Traumatic / mortality
  • Female
  • Humans
  • Intracranial Hemorrhage, Traumatic / drug therapy
  • Intracranial Hemorrhage, Traumatic / mortality
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Subarachnoid Hemorrhage, Traumatic / mortality*
  • Subarachnoid Hemorrhage, Traumatic / surgery
  • Tranexamic Acid / pharmacology*
  • Young Adult


  • Tranexamic Acid