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

Interpretation Our results show that tranexamic acid is safe in patients with traumatic brain injury and that treatment within 3 h of injury reduces head injury-related death

2019

Scholarcy highlights

  • Each year, worldwide, there are more than 60 million new cases of traumatic brain injury. Road traffic crashes and falls are the main causes and the inci­ dence is increasing. Intracranial bleeding is a common complication of TBI and increases the risk of death and disability. bleeding can start from the moment of impact, it often continues for several hours after injury. Ongoing intracranial bleeding can lead to raised intracranial pressure, brain herniation, and death
  • Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group
  • In the prespecified sensitivity analysis that excluded patients with a Glasgow Coma Scale score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group
  • The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury but not in patients with severe head injury
  • Intracranial bleeding is common after traumatic brain injury and increases head injury-related death and disability
  • Added value of this study Our study found that the risk of death from head injury was reduced in patients treated with tranexamic acid, when patients who had a Glasgow Coma Scale score of 3 and those with bilateral unreactive pupils at baseline were excluded
  • We aimed to assess the effects of tranexamic acid in patients with traumatic brain injury

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