15MoscoteSalazar_An international


 

 

 

 

 
248 | Moscote-Salazar et al - Survey on perioperative use of tranexamic acid in neurotrauma 

 

 

 

 

 

 

 

An international based survey on perioperative use of 

tranexamic acid in neurotrauma 

Luis Rafael Moscote-Salazar1, Amit Agrawal2, Andres M. Rubiano3, 

Mohammed Al Dhahir4, Willem Guillermo Calderon-Miranda5, 

Nasly Zabaleta-Churio6, Marco Antonio Blancas Rivera7 

1Neurosurgeon-Critical Care, RED LATINO Latin American Trauma & Intensive Neuro-Care 

Organization. Bogota, Colombia 
2Professor of Neurosurgery, MM Institute of Medical Sciences & Research, Maharishi 

Markandeshwar University, Mullana - Ambala, Haryana, India 
3Neurosurgeon, Professor of neuroscience and neurosurgery, Universidad El Bosque 

RED LATINO Latin American Trauma & Intensive Neuro-Care Organization, Bogota, Colombia 
4Neurosurgeon, Al-Thawra Modern General Hospital, Yemen 
5National Autonomous University of Mexico. UNAM, Mexico D.F, Mexico 
6Nurse, Universidd Popular del Cesar, Colombia 
7National Autonomous University of Mexico, UNAM, Mexico D.F, Mexico 

 
Abstract: Background: Tranexamic acid is used to reduce bleeding, easy to use, affordable 

and relatively safe. There are few studies on the use of tranexamic acid in trauma and 

especially in neurosurgery. There is no published study on the trend the use of 

tranexamic acid in neurotrauma surgery among international doctors. The aim of this 

study was to evaluate the current practice for use of tranexamic acid during neurotrauma 

surgery. Materials and Methods: A 11-question electronic survey was sent to 25 

practicing physicians worldwide. Basic demographic information and estimated rates of 

use of tranexamic acid during neurotrauma surgery. Results: Twenty five physicians 

responded to our survey. Very Few trusts (12%) use tranexamic acid during 

neurotraumasurgery. Conclusion: Further studies are required to establish guidelines in 

neurosurgery and neurotrauma, especially. The use of this medicine potentially helps 

improve patient care with head injury and save lives. 

Key words: Neurotrauma surgery, survey, tranexamic acid, trauma 

 

 

 

 



 

 

 

 

 
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Introduction 

Traumatic brain injury has been associated 

with significant mortality in the acute period. 

(1,2,3,4). There is great interest for the use of 

strategies that allow the decrease of bleeding 

within the surgical period. Very few trends 

studies have evaluated the use of tranexamic 

acid in surgery. (5,6). Until this date there is no 

study to assess the practical use of tranexamic 

acid in neuronal trauma surgery. The aim of 

this study was to record the use of tranexamic 

acid for neurotrauma surgery in physicians 

worldwide 

Materials and methods 

To determine how physicians 

internationally use tranexamic acid in brain 

trauma surgeries; we developed a web-based 

structured survey with real time results 

through an online survey 

(http://www.neuropractice.com). Survey 

invitations were sent by e-mail, and aimed 

physicians (Neurosurgeons, intensivist, 

residents of neurosurgery/critical care, trauma 

surgeons and others) who manage patients 

with brain traumatic injury, during the month 

of August of 2015 to September of 2015. For 

ethical considerations was decided not to 

identify any of the physician surveyed. We 

used dichotomous choice questions, and 

multiple choice questions with single answers. 

The evaluated variables were:  experience, 

occupation, place of training and use of 

ventriculostomy and placement of an 

intracranial pressure monitoring device. 

Answers from the survey were compiled and 

entered into an Excel database (Microsoft, 

Redmond, Washington). Each answer to a 

question was placed in a corresponding 

category and the frequencies of each category 

were computed. The data was analyzed by 

software 17.0 (SPSS. Inc., Chicago, IL). The 

data obtained was analyzed statistically and 

was determined the frequency distribution of 

each of the variables. 

Results 

Twenty five international physician 

completed the survey, all physician practiced 

in many countries. The time, of experienced 

was analyzed: 0-5 years (16%; n= 4), 5-10 years 

(20%; n=5), 10-20 years (36%; n=9), 21-

30(28%; n=7) years.  When asked about 

occupation the results were; neurosurgeon 

(32%; n=8), intensivist (36%; n=9), resident of 

neurosurgery/critical care (8%; n=2), trauma 

surgeon (8%; n=2), anesthesiologist (4%; n=1), 

RN critical care (4 %; n=1), others (8%; n=2). 

When asked about the use of tranexamic acid; 

yes (52%; n=13) and no (48%; n=12). When 

asked about the existence of an institutional 

policy for the use of tranexamic acid; yes (52%; 

n=13) and no (48%; n=12). When asked about 

the use tranexamic acid for all patients on 

neurotrauma surgery, (12%; n=3) and not 

(88%; n=22). When asked about the use of 

Tranexamic Acid in subdural chronic 

hematoma, yes (20%; n=5) and no (80%; 

n=20). When asked about the use Tranexamic 

Acid in recurrent subdural chronic hematoma; 

yes (12%; n=3) and no (88%; n=22). When 

asked about the   use Tranexamic Acid in 

Epidural hematoma; yes (36%; n=9) and no 

(64%; n=16). When asked about the use 

Tranexamic Acid in Acute subdural 



 

 

 

 

 
250 | Moscote-Salazar et al - Survey on perioperative use of tranexamic acid in neurotrauma 

 

 

 

 

 

 

 

hematoma; yes (44%; n=11) and no (56%; 

n=14). Regarding the discontinuation of 

maintenance (Tranexamic Acid) at the time of 

skin closure was performed; yes (16%; n=4) 

and no (84%; n=21). Other concern for the 

evaluation was the consideration of use with 

continuous infusion in the intensive care unit; 

yes (32%; n=8) and no (68%; n=17). 

Discussion 

Tranexamic acid is a synthetic derivative of 

the amino acid lysine that exerts its 

antifibrinolytic effect through the reversible 

blockade of lysine binding sites on 

plasminogen molecules. (6,7). The publication 

of the CRASH-2 trial opened a great interest in 

relation to the use of tranexamic acid and 

bleeding.  (9). This has motivated the interest 

on the role of fibrinolysis in bleeding. It has 

been shown that the effect of tranexamic acid 

is greater the day of injury; it also reduces the 

risk of death from all causes by 20%. It has 

been established that survival is only evident in 

patients treated initially in the first 3 hours.  

Until this day, no study has surveyed the use of 

tranexamic acid in patients with neuronal 

trauma. From this survey we can infer that 

52% of respondents’ trusts routinely use 

tranexamic acid in neurosurgery. Our results 

show an institutional policy for the use of 

tranexamic acid in 52%. There is disparity in 

the use of tranexamic acid; low use in neuronal 

trauma surgery in these cases may be 

beneficial. It is possible that some concerns 

about the possible complications derived from 

this drug are the reason of the low use of 

tranexamic acid. These complications have 

been estimated as too low. (10,11,12) Despite 

evidence showing this drug is much useful and 

has low risk of side effects, it is clear that its use 

is not part of routine practice in many of the 

same neurosurgical centers. 

Conclusion 

This survey shows on the current practice 

of physicians who specialize in neurotrauma 

surgery and tranexamic acid. As a relevant 

conclusion, further studies are required to 

achieve to provide a definitive dosing 

recommendations. Also, to confirm the role of 

tranexamic acid in the management of 

neurotrauma surgery and so the improvement 

of patient care. 

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