{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T13:34:22Z","timestamp":1770989662933,"version":"3.50.1"},"reference-count":47,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Intracranial hemorrhage is a leading cause of secondary brain injury following traumatic brain injury (TBI). Tranexamic acid (TXA), an antifibrinolytic agent, is recommended by Advanced Trauma Life Support for hemorrhagic trauma, but its role in TBI remains debated. Recent meta-analyses and randomized controlled trials (RCTs) have demonstrated conflicting results regarding TXA\u2019s mortality benefits, while beta-blockers (BBs) show potential in mitigating hyperadrenergic states post-TBI. This study aims to update the evidence on TXA and BB administration in TBI by incorporating newer RCTs and systematic reviews published post-February 2023.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A systematic search of PubMed, ScienceDirect, and clinicaltrials.gov was conducted using keywords: \u201ctranexamic acid,\u201d \u201cbeta blockers,\u201d and \u201ctraumatic brain injury.\u201d Studies published up to December 2024 were included to address gaps in the literature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and data were analyzed using RevMan 5. Primary outcomes were the safety and efficacy of TXA and BB.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Thirteen RCTs (\n n<\/jats:italic>\n = 16,452) were included, expanding on prior meta-analyses. TXA did not significantly reduce mortality (relative risk 0.93, 95% confidence intervals [CI] 0.86\u20131.01) but reduced hematoma progression (mean difference \u22123.67 cm\n 3<\/jats:sup>\n ,*\n P<\/jats:italic>\n * = 0.007). BB showed a non-significant mortality reduction (13.65% vs. 18.34%; Odds ratio [OR] 0.55 [95% CI 0.27\u20131.13]). Adverse events were comparable between groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n TXA and BB are safe but do not significantly improve mortality in TBI. Our updated analysis aligns with recent literature, underscoring the need for further RCTs to clarify subgroups (e.g., mild-moderate TBI) that may benefit.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_598_2025","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:28:39Z","timestamp":1770985719000},"page":"77","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and efficacy of tranexamic acid and beta-blockers for traumatic brain injury: A systematical review and meta-analysis"],"prefix":"10.25259","volume":"17","author":[{"given":"Ahmad","family":"Faried","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Universitas`1` Padjadjaran, Bandung, West Java, Indonesia"},{"name":"Kontrasia ATLS, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita Trisnawati","family":"Sugianto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universitas`1` Padjadjaran, Bandung, West Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rivan","family":"Dwiutomo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universitas`1` Padjadjaran, Bandung, West Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya","family":"Wicaksana","sequence":"additional","affiliation":[{"name":"Kontrasia ATLS, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I. Nengah Kuning","family":"Atmadjaya","sequence":"additional","affiliation":[{"name":"Kontrasia ATLS, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"10.25259\/SNI_598_2025\/ref-1","doi-asserted-by":"crossref","first-page":"1284016","DOI":"10.3389\/fmed.2023.1284016","article-title":"Prehospital tranexamic acid in trauma patients: A systematic review and meta-analysis of randomized controlled trials","volume":"10","author":"Acharya","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"10.25259\/SNI_598_2025\/ref-2","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1097\/SLA.0000000000002286","article-title":"Beta-blockers and traumatic brain injury: A systematic review, meta-analysis, and eastern association for the surgery of trauma guideline","volume":"266","author":"Alali","year":"2017","journal-title":"Ann Surg"},{"key":"10.25259\/SNI_598_2025\/ref-3","first-page":"1140","article-title":"Karakteristik pasien amnesia pasca cedera otak di RSUD provinsi nusa tenggara barat","volume":"11","author":"Alfian","year":"2022","journal-title":"J Kedokt"},{"key":"10.25259\/SNI_598_2025\/ref-4","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1089\/neu.2022.0068","article-title":"Traumatic brain injury in select low-and middle-income countries: A narrative review of the literature","volume":"40","author":"Allen","year":"2023","journal-title":"J Neurotrauma"},{"issue":"S4","key":"10.25259\/SNI_598_2025\/ref-5","first-page":"10","article-title":"Prehospital cardiac arrest management: A narrative review","volume":"21","author":"Alzahrani","year":"2025","journal-title":"Rev Diabet Stud"},{"key":"10.25259\/SNI_598_2025\/ref-6","doi-asserted-by":"crossref","first-page":"e857","DOI":"10.4088\/JCP.15f10150","article-title":"Understanding relative risk, odds ratio, and related terms: As simple as it can get","volume":"76","author":"Andrade","year":"2015","journal-title":"J Clin Psychiatry"},{"key":"10.25259\/SNI_598_2025\/ref-7","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/TA.0000000000003767","article-title":"The effects of timing of prehospital tranexamic acid on outcomes after traumatic brain injury: Subanalysis of a randomized controlled trial","volume":"94","author":"Brito","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"10.25259\/SNI_598_2025\/ref-8","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jcrc.2017.05.035","article-title":"Therapeutic effect of beta-blocker in patients with traumatic brain injury: A systematic review and meta-analysis","volume":"41","author":"Chen","year":"2017","journal-title":"J Crit Care"},{"key":"10.25259\/SNI_598_2025\/ref-9","doi-asserted-by":"crossref","first-page":"301","DOI":"10.4097\/kja.25001","article-title":"Heterogeneity in meta-analyses: An unavoidable challenge worth exploring","volume":"78","author":"Choi","year":"2025","journal-title":"Korean J Anesthesiol"},{"key":"10.25259\/SNI_598_2025\/ref-10","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/S0140-6736(19)32233-0","article-title":"Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomised, placebo-controlled trial","volume":"394","author":"CRASH-3 Trial Collaborators","year":"2019","journal-title":"Lancet"},{"key":"10.25259\/SNI_598_2025\/ref-11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s13054-016-1432-0","article-title":"The critical care management of spontaneous intracranial hemorrhage: A contemporary review","volume":"20","author":"De Oliveira Manoel","year":"2016","journal-title":"Crit Care"},{"key":"10.25259\/SNI_598_2025\/ref-12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5195\/jmla.2022.1283","article-title":"MeSH and text-word search strategies: Precision, recall, and their implications for library instruction","volume":"110","author":"DeMars","year":"2022","journal-title":"J Med Libr Assoc"},{"key":"10.25259\/SNI_598_2025\/ref-13","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1089\/neu.2023.0417","article-title":"A systematic review of reported outcomes in randomized controlled trials targeting early interventions in moderate-to-severe traumatic brain injury","volume":"41","author":"Derouin","year":"2024","journal-title":"J Neurotrauma"},{"key":"10.25259\/SNI_598_2025\/ref-14","doi-asserted-by":"crossref","first-page":"111407","DOI":"10.1016\/j.jclinepi.2024.111407","article-title":"The impact of an online course on agreement rates of the certainty of evidence assessment using grading of recommendations, assessment, development, and evaluation approach: A before-and-after study","volume":"172","author":"Dorneles","year":"2024","journal-title":"J Clin Epidemiol"},{"key":"10.25259\/SNI_598_2025\/ref-15","doi-asserted-by":"crossref","first-page":"19574","DOI":"10.1038\/s41598-024-70470-y","article-title":"Systemic and cerebro-cardiac biomarkers following traumatic brain injury: An interim analysis of randomized controlled clinical trial of early administration of beta blockers","volume":"14","author":"El-Menyar","year":"2024","journal-title":"Sci Rep"},{"key":"10.25259\/SNI_598_2025\/ref-16","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/PHM.0000000000002656","article-title":"Overview of Medical, surgical, and rehabilitation outcome measures used in randomized controlled trials of moderate to severe traumatic brain injury","volume":"104","author":"Flores-Sandoval","year":"2025","journal-title":"Am J Phys Med Rehabil"},{"key":"10.25259\/SNI_598_2025\/ref-17","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1080\/02688697.2021.1940850","article-title":"Hemoglobin levels as a transfusion criterion in moderate to severe traumatic brain injury: A systematic review and meta-analysis","volume":"37","author":"Florez-Perdomo","year":"2023","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_598_2025\/ref-18","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.annemergmed.2023.10.004","article-title":"Tranexamic acid for traumatic injury in the emergency setting: A systematic review and bias-adjusted meta-analysis of randomized controlled trials","volume":"83","author":"Fouche","year":"2024","journal-title":"Ann Emerg Med"},{"key":"10.25259\/SNI_598_2025\/ref-19","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/S1474-4422(23)00287-9","article-title":"Global, regional, and national burden of spinal cord injury 1990-2019: A systematic analysis for the global burden of disease study 2019","volume":"22","author":"GBD Spinal Cord Injuries Collaborators","year":"2023","journal-title":"Lancet Neurol"},{"key":"10.25259\/SNI_598_2025\/ref-20","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12871-019-0772-0","article-title":"Different dose regimes and administration methods of tranexamic acid in cardiac surgery: A meta-analysis of randomized trials","volume":"19","author":"Guo","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"10.25259\/SNI_598_2025\/ref-21","first-page":"1","article-title":"Oral presentations 2023 AANS annual scientific meeting","volume":"138","author":"Han","year":"2023","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_598_2025\/ref-22","doi-asserted-by":"crossref","first-page":"e78654","DOI":"10.7554\/eLife.78654","article-title":"Mitochondrial redox adaptations enable alternative aspartate synthesis in SDH-deficient cells","volume":"12","author":"Hart","year":"2023","journal-title":"Elife"},{"key":"10.25259\/SNI_598_2025\/ref-23","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1161\/CIRCULATIONAHA.123.064274","article-title":"Multicenter, prospective, randomized controlled trial of high-sensitivity cardiac troponin I-guided combination angiotensin receptor blockade and beta-blocker therapy to prevent anthracycline cardiotoxicity: The cardiac CARE trial","volume":"148","author":"Henriksen","year":"2023","journal-title":"Circulation"},{"key":"10.25259\/SNI_598_2025\/ref-24","first-page":"e314","article-title":"2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: A guideline from the American heart association\/American stroke association","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"10.25259\/SNI_598_2025\/ref-25","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1111\/anae.14903","article-title":"Role of patient-centred outcomes after hospital discharge: A state-of-the-art review","volume":"75","author":"Ladha","year":"2020","journal-title":"Anaesthesia"},{"key":"10.25259\/SNI_598_2025\/ref-26","doi-asserted-by":"crossref","first-page":"194","DOI":"10.23736\/S0375-9393.18.13070-7","article-title":"Why do multicenter randomized controlled trials not confirm the positive findings of single center randomized controlled trials in acute care?","volume":"85","author":"Landoni","year":"2019","journal-title":"Minerva Anestesiol"},{"key":"10.25259\/SNI_598_2025\/ref-27","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s00134-020-06279-w","article-title":"Efficacy and safety of tranexamic acid in acute traumatic brain injury: A systematic review and meta-analysis of randomized-controlled trials","volume":"47","author":"Lawati","year":"2021","journal-title":"Intensive Care Med"},{"key":"10.25259\/SNI_598_2025\/ref-28","first-page":"64","article-title":"Cardiovascular emergencies","volume-title":"Patient transport: Medical critical care-E-book: Patient transport: Medical critical care-E-book","author":"Layell","year":"2024"},{"key":"10.25259\/SNI_598_2025\/ref-29","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"Lancet Neurol"},{"key":"10.25259\/SNI_598_2025\/ref-30","first-page":"e73781","article-title":"Efficacy and safety of tranexamic acid in traumatic brain injury: A systematic review and meta-analysis of randomized controlled trials","volume":"16","author":"Meer","year":"2024","journal-title":"Cureus"},{"key":"10.25259\/SNI_598_2025\/ref-31","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1001\/jamapediatrics.2021.0878","article-title":"Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: International clinical practice guideline based on systematic reviews","volume":"175","author":"Morgan","year":"2021","journal-title":"JAMA Pediatr"},{"key":"10.25259\/SNI_598_2025\/ref-32","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyana web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"10.25259\/SNI_598_2025\/ref-33","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.25259\/SNI_598_2025\/ref-34","article-title":"Intracerebral hemorrhage","volume-title":"StatPearls","author":"Rajashekar","year":"2025"},{"key":"10.25259\/SNI_598_2025\/ref-35","first-page":"1088","article-title":"Effect of tranexamic acid on progression of hematoma in traumatic brain injury: A randomized controlled trial","volume":"33","author":"Rashid","year":"2024","journal-title":"Mymensingh Med J"},{"key":"10.25259\/SNI_598_2025\/ref-36","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S0735-1097(99)00351-4","article-title":"1999 update: ACC\/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American college of cardiology\/American heart association task force on practice guidelines (committee on management of acute myocardial infarction)","volume":"34","author":"Ryan","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"10.25259\/SNI_598_2025\/ref-37","doi-asserted-by":"crossref","first-page":"430","DOI":"10.3171\/2022.5.JNS22664","article-title":"Adjuvant oral tranexamic acid and reoperation after burr hole surgery in patients with chronic subdural hematoma: Propensity score-matched analysis using a nationwide inpatient database","volume":"138","author":"Shibahashi","year":"2023","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_598_2025\/ref-38","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1055\/s-0042-1757217","article-title":"Prognostic role of catecholamine in moderate-to-severe traumatic brain injury: A prospective observational cohort study","volume":"17","author":"Singh","year":"2022","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_598_2025\/ref-39","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13049-024-01188-z","article-title":"Therapeutic efficacy of tranexamic acid on traumatic brain injury: A systematic review and meta-analysis","volume":"32","author":"Song","year":"2024","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"10.25259\/SNI_598_2025\/ref-40","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"10.25259\/SNI_598_2025\/ref-41","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1089\/neu.2023.0383","article-title":"Comparing randomized controlled trials of moderate to severe traumatic brain injury in lower to middle income countries versus high income countries","volume":"41","author":"Teasell","year":"2024","journal-title":"J Neurotrauma"},{"key":"10.25259\/SNI_598_2025\/ref-42","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/TA.0000000000004500","article-title":"Optimal dose of tranexamic acid in traumatic brain injury: Systematic review and network meta-analysis of randomized controlled trials","volume":"98","author":"Utsumi","year":"2025","journal-title":"J Trauma Acute Care Surg"},{"key":"10.25259\/SNI_598_2025\/ref-43","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.annemergmed.2024.07.014","article-title":"Tranexamic acid in pediatric traumatic brain injury: A multicenter retrospective observational study","volume":"85","author":"Utsumi","year":"2025","journal-title":"Ann Emerg Med"},{"key":"10.25259\/SNI_598_2025\/ref-44","doi-asserted-by":"crossref","first-page":"uhae170","DOI":"10.1093\/hr\/uhae170","article-title":"Panax notoginseng Panoramagram of phytochemical and pharmacological properties, biosynthesis, and regulation and production of ginsenosides","volume":"11","author":"Wei","year":"2024","journal-title":"Hortic Res"},{"key":"10.25259\/SNI_598_2025\/ref-45","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.wneu.2018.11.214","article-title":"Effect of tranexamic acid in patients with traumatic brain injury: A systematic review and meta-analysis","volume":"123","author":"Weng","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_598_2025\/ref-46","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ahj.2015.04.008","article-title":"Patient-centered research into outcomes stroke patients prefer and effectiveness research: Implementing the patient-driven research paradigm to aid decision making in stroke care","volume":"170","author":"Xian","year":"2015","journal-title":"Am Heart J"},{"key":"10.25259\/SNI_598_2025\/ref-47","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ajem.2024.03.005","article-title":"Efficacy and safety of tranexamic acid in acute traumatic brain injury: A meta-analysis of randomized controlled trials","volume":"80","author":"Zhang","year":"2024","journal-title":"Am J Emerg Med"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/safety-and-efficacy-of-tranexamic-acid-and-beta-blockers-for-traumatic-brain-injury-a-systematical-review-and-meta-analysis\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/safety-and-efficacy-of-tranexamic-acid-and-beta-blockers-for-traumatic-brain-injury-a-systematical-review-and-meta-analysis\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:28:44Z","timestamp":1770985724000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/safety-and-efficacy-of-tranexamic-acid-and-beta-blockers-for-traumatic-brain-injury-a-systematical-review-and-meta-analysis\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":47,"alternative-id":["10.25259\/SNI_598_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_598_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,13]]},"article-number":"77"}}