D. Deshpande2, W. McKinley1, A. Benjamin1, M. Schreiber3, S. Rowell1 3Oregon Health And Science University, Division Of Trauma, Critical Care And Acute Care Surgery, Portland, OR, USA 1University Of Chicago, Department Of Surgery, Chicago, IL, USA 2University Of Chicago, Pritzker School Of Medicine, Chicago, IL, USA
Introduction:
Tranexamic acid (TXA) has been shown to reduce mortality in patients with traumatic brain injury (TBI) when given within two hours of injury. TXA also reduces the seizure threshold in a dose-dependent manner. We examined whether a 2g bolus of prehospital TXA given to patients with moderate or severe TBI is associated with seizure activity within 72-hours of injury.
Methods:
We performed a retrospective analysis of the Prehospital TXA for TBI Trial, which randomized patients with prehospital GCS<13 and SBP>90 to placebo, 2g TXA bolus (bolus-only), or 1g TXA bolus+1g 8-hour TXA infusion (bolus-maintenance) within two hours of injury. We included patients with GCS<13, blunt mechanism of injury, and complete seizure data. Seizures were defined as observed seizure-like activity and administration of anti-seizure medication in the prehospital setting or electroencephalogram confirmation in-hospital. Multivariable logistic regression models were used to identify variables associated with seizure, controlling for treatment group, age, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) – head, intracranial hemorrhage (ICH), and home anti-seizure medication use. Multivariable logistic regression models controlling for the same variables (except anti-seizure medication) were also created to examine associations with 28-day mortality, 6-month Disability Rating Scale (DRS), and 6-month Glasgow Outcome Scale – Extended (GOSE). GOSE was dichotomized into unfavorable (1-4) and favorable (5-8) outcomes and DRS was dichotomized into favorable (0-7) and unfavorable (8-30).
Results:
Of 966 patients in the parent trial’s analysis population, 786 met the inclusion criteria (placebo: n=249; bolus-maintenance: n=243; bolus-only: n=294). The median age of the bolus-only group (42, IQR 27 to 56) was significantly different than the placebo group (35, IQR 24 to 51) (p=0.03). AIS-Head, GCS, ISS, ICH, and home anti-seizure medications were not different between groups. Nineteen patients had seizures within 72 hours: 5 in placebo, 2 in bolus-maintenance, and 12 in bolus-only. A 2g TXA bolus was not associated with increased seizures compared to placebo (OR 0.41, 95% CI 0.12 – 1.18, p=0.12). However, home anti-seizure medication use was associated with increased seizures (OR 15.95, 95% CI 3.79 – 60.57, p<0.001) (Table 1). Patient outcomes were not associated with seizure incidence (28-day mortality: p=0.33; GOSE p=0.57; DRS: p=0.60).
Conclusion:
In this retrospective analysis of prehospital TXA administration in patients with moderate or severe TBI, a 2g bolus of TXA given within 2 hours of injury was not associated with increased seizure activity in the first 72 hours of hospital admission.
