Globally, more than 60 million cases of traumatic brain injury occur annually, most of which are due to motor vehicle crashes and falls. Tranexamic acid (TXA), an antifibrinolytic drug which slows the breakdown of blood clots and prevents prolonged bleeding, has been shown to reduce bleeding and mortality in patients with severe trauma, post-partum hemorrhage, and extracranial bleeding. Results from the CRASH-3 randomized, controlled trial recently published in The Lancet show that TXA also reduces the risk of mortality in patients with traumatic brain injury (TBI) with intracranial bleeding. Over 6.5 years, 12,737 patients (mean age, 42 years; 80% men) with severe to moderate TBI and no major extracranial bleeding from 29 countries were randomly assigned within 3 hours of injury to receive either TXA or placebo. The risk of head-injury related mortality was 18.5% (855/4613) in the TXA group and 19.8% (892/4514) in the placebo group (risk ratio, 0.94 [95% CI, 0.86-1.02]), but the effect of TXA was more pronounced in patients treated early with mild-to-moderate head injury (risk ratio, 0.78 [95% CI, 0.64-0.95]). Importantly, TXA appeared to be safe and did not increase the risk of vascular occlusive events. Patients with TBI should rapidly be treated with TXA, but further research should investigate the optimal dosage and safety.
References:
- The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomized, placebo-controlled trial. The Lancet 2019; 394; 1713-1723.
- Cap AP. CRASH-3: A win for patients with traumatic brain injury. The Lancet 2019; 394; 1687-1688.
