Tranexamic acid could reduce head injury deaths by ‘hundreds of thousands’

Written by Sharon Salt, Editor

Tranexamic acid – a low-cost and widely available drug that prevents bleeding into the brain by inhibiting blood clot breakdown – could reduce deaths in individuals with traumatic brain injury by as much as 20%, depending on the severity of the injury.

The results, recently published in The Lancet, included more than 12,000 individuals who were recruited from 175 hospitals across 29 countries. Within the study, also termed the Clinical Randomization of an Antifibrinolytic in Significant Head Injury (CRASH-3), participants were given either intravenous tranexamic acid or a placebo.

The results indicated that within 3 hours post-injury with tranexamic acid administration, the number of deaths were reduced. This effect was greatest in participants who had mild and moderate traumatic brain injury (20% reduction in deaths). However, no clear benefit was observed in the most severely injured patients.

The researchers also reported that there was no evidence of adverse effects and no increase in disability in survivors when the drug was administered.

Although patients who have very severe injuries are unlikely to benefit from tranexamic acid treatment (due to extensive bleeding in the brain prior to hospital admission and treatment), the study conveyed a substantial benefit in individuals who have less severe injuries (who comprise over 90% of traumatic brain injury cases).

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“We already know that rapid administration of tranexamic acid can save lives in patients with life-threatening bleeding in the chest or abdomen such as we often see in victims of traffic crashes, shootings or stabbings. This hugely exciting new result shows that early treatment with tranexamic acid also cuts deaths from head injury,” commented co-lead author of the study, Ian Roberts (London School of Hygiene and Tropical Medicine, UK).

“It’s an important breakthrough and the first neuroprotective drug for patients with head injury,” Roberts added.

As tranexamic acid cannot undo damage that has already occurred, it’s critical that early treatment is given. Results from the trial data revealed a 10% reduction in the effectiveness of the treatment for every 20-minute delay, suggesting that administration of the drug should be given to patients as soon as possible following a head injury.

One limitation of the study that was noted by the authors included that more patients with unsurvivable head injuries were included in the trial than anticipated, which may have diluted the treatment effect.

Sources: 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 doi:10.1016/S0140-6736(19)32233-0 (2019) (Epub ahead of print);