Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an…

Meta-analysisFrontiers in neurology· 2026

Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an updated systematic review and meta-analysis of randomized controlled trials.

Zhengyi Zhang, Zilin He, Kunlan Long

Neurological SurgeryMeta-analysisTreatmentQ2IF 3.1

Tranexamic acid did not reduce short-term mortality in hemorrhagic acute brain injury.

Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an updated systematic review and meta-analysis of randomized controlled trials.

Zhengyi Zhang … Kunlan Long

Frontiers in neurology · 2026 · Q2 in Neurology

Background

Hemorrhagic acute brain injury-encompassing traumatic brain injury, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage-carries substantial morbidity and mortality.

Purpose

To evaluate the effect of tranexamic acid on neurological outcomes and all-cause mortality in adults with acute brain injury.

Methods

In accordance with the PRISMA 2020 statement, we systematically searched PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library from inception to April 2026.

n = 12,000 patients

Results

no significant reduction in short-term death with tranexamic acid

RR by subgroup · 95% CI

More results

For neurological outcomes, tranexamic acid neither improved the proportion of patients with functional independence (RR 0.97, 95% CI 0.92-1.03) nor reduced the risk of functional dependence or death (RR 1.01, 95% CI 0.96-1.07).

More results

For rebleeding, the pooled estimate showed no statistically significant effect (RR 0.81, 95% CI 0.59-1.11), with substantial between-study heterogeneity ( I 2 = 72%).

The current evidence is inconclusive regarding a protective effect of tranexamic acid on rebleeding.

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Conclusion

Tranexamic acid did not improve all-cause mortality or neurological outcomes in hemorrhagic acute brain injury, and the evidence for its effect on rebleeding remains inconclusive.

Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an updated systematic review and meta-analysis of randomized controlled trials.

Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an updated systematic review and meta-analysis of randomized controlled trials.

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