Systematic ReviewResearchMedication Safety

Tranexamic acid did not improve outcomes across seven hemorrhagic brain-injury trials

Frontiers in neurology (PubMed)Jul 31, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review and meta-analysis of seven randomized trials involving more than 12,000 adults found no significant improvement in mortality or neurological outcomes with tranexamic acid across hemorrhagic acute brain injuries.

What NurseJet pulled from the source

Tranexamic acid did not significantly change short- or long-term mortality, functional independence, functional dependence or death, rebleeding, or thromboembolic events versus placebo. The rebleeding estimate was imprecise and heterogeneous, so the authors considered that outcome inconclusive rather than evidence of no possible effect.

Why this matters for nurses

Critical-care, emergency, and neurology nurses administer time-sensitive hemostatic therapy while tracking neurologic status, bleeding, and thrombotic complications. The pooled null result cautions against assuming that tranexamic acid provides a universal outcome benefit across distinct hemorrhagic brain injuries.

Bedside takeaway

Do not generalize a tranexamic-acid benefit across all hemorrhagic brain injuries; use the indication-specific protocol and monitor closely.

How This Applies in Practice

Use this when: Administering or monitoring tranexamic acid for an adult with acute hemorrhagic brain injury under an indication-specific emergency or critical-care protocol.

On your shift

Verify the diagnosis-specific indication, ordered dose, timing, contraindication screen, vascular access, and concurrent hemostatic plan before administration.
Trend neurologic findings, hemodynamics, bleeding or rebleeding indicators, and signs of venous or arterial thromboembolism through the required observation period.
Escalate neurologic deterioration, recurrent bleeding concern, suspected thrombosis, medication error, or uncertainty about whether the patient meets protocol criteria.

Keep in mind: This pooled null result does not replace diagnosis- and timing-specific treatment pathways or authorize withholding an ordered therapy. Follow the emergency or critical-care protocol, facility medication policy, and provider orders.

Key takeaways

The review included seven randomized placebo-controlled trials and more than 12,000 hospitalized adults with traumatic brain injury, intracerebral hemorrhage, or subarachnoid hemorrhage.
Short-term mortality was not significantly reduced, with a pooled risk ratio of 0.93 and a 95% confidence interval reaching 1.00.
Tranexamic acid did not improve functional independence or reduce the combined outcome of functional dependence or death.
Rebleeding and thromboembolic events did not differ significantly, but rebleeding results had substantial between-study heterogeneity.

Practice implications

Use tranexamic acid only for the protocol-defined indication and ordered regimen, verify dose and timing, and continue serial neurologic, bleeding, and thromboembolic surveillance. Do not interpret the pooled finding as a reason to delay or independently change an indication-specific treatment plan.

Limitations & cautions

The review pooled three clinically distinct conditions: traumatic brain injury, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage. Aggregate results may not resolve timing-dependent or diagnosis-specific effects, and rebleeding estimates were heterogeneous and inconclusive.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Frontiers in neurology (PubMed)

Frontiers in neurology (PubMed). 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.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42602263/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

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At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

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