The results of a new study, published in The Lancet, suggest that tranexamic acid (TXA) could reduce TBI deaths by as much as 20%, depending on the severity of the injury.
Traumatic brain injury (TBI) is a serious public health concern. In 2014, about 2.87 million cases of TBI occurring the United States each year, according to the American Association of Neurological Surgeons, and there are approximately 69 million new cases of TBI each year worldwide.
Accounting for upwards of 90% of all TBIs, mild to moderate TBIs are much more common than severe TBIs. Serious complications can still occur in mild to moderate TBI.
Intracranial bleeding is a common and serious complication of TBI; researchers in one study found that nearly 46% of participants with TBI having epidural hemorrhage (EDH), intraparenchymal hemorrhage (IPH), subdural hemorrhage (SDH), or subarachnoid hemorrhage (SAH). Intracranial bleeding increases the risk of mortality and disability. Often starting at the moment of traumatic impact and continuing for several hours, intracranial bleeding can raise intracranial pressure and lead to brain herniation and death.
CRASH-3 Results Show Great Promise for the Use of TXA in Mild to Moderate TBI
TXA is an inexpensive and widely available drug that reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding by inhibiting fibrinolysis.
TXA already saves lives with life-threatening bleeding in the chest or abdomen seen after vehicle crashes, shootings and stabbings. The results of this study suggest it can benefit patients suffering from intracranial bleeding associated with TBI.
The Clinical Randomisation of an Antifbrinolytic in Significant Head Injury (CRASH-3) trial is one of the most substantial TBI studies ever conducted. In CRASH-3, researchers from the London School of Hygiene & Tropical Medicine performed a global randomized trial that included 12,737 head injury patients from 175 hospitals across 29 countries.
Participants received either intravenous tranexamic acid or a placebo. The results of the study show that administration of TXA within three hours of the injury reduced the number of deaths.
TXA reduced deaths by 20% in patients with mild and moderate TBI. TXA provided no clear benefit in reducing mortality in patients with severe TBI. This is likely due to the extensive brain bleeding prior to hospital admission and treatment.
TXA prevents bleeding from getting worse but it cannot reverse damage, so early treatment is critical for an optimal outcome. The research demonstrated a 10% reduction in effectiveness for every 20-minute delay. This suggests emergency personnel should administer TXA as soon as possible after the head injury.
The researchers found no evidence of increased risk of adverse effects. Specifically, the risk of deep vein thrombosis, (DVT), pulmonary embolism (PE), myocardial infarction (MI) and stroke was similar for those in the placebo and the TXA groups. Furthermore, there was no increase in disability in survivors who received TXA.
Limitations the trial included wide confidence intervals and an unanticipated inclusion of patients with unsurvivable TBIs, which diluted the treatment effect.
CRASH-3 supports a previous study involving 20,000 trauma patients that showed TXA could reduce extracranial bleeding deaths by nearly one-third if administered within three hours. Widely implemented in both low- and high-income countries around the world, TXA treatment of TBI could save hundreds of thousands of lives each year.
