Transexamic acid (TXA) has been demonstrated to reduce mortality significantly in patients with extracranial bleeding by inhibiting fibrinolysis to reduce hemorrhage. In patients with traumatic brain injury (TBI), progression of hematoma is a known complication and a majhor potential cause of death. Because TXA was shown in two prior small trials to reduce mortality, the CRASH 3 trial was launched as a multi-institutional, double blinded randomized control study to examine the effect of early TXA administration for TBI patients. TBI patients (defined as <GCS 12 or head CT showing hemorrhage) were randomly assigned to either getting TXA (1g bolus follow by 1g infused over 8 hour) or normal saline. Primary outcome was injury-related death within 28 days. The overall mortality was lower in patients who received TXA within 3 hours of injury, but not statistically significant from control patients. However, in subgroup analysis, patients with mild-moderate TBI treated with TXA had a significantly lower mortality rate compared to placebo-treated group (RR 0.78, 95% CI 0.64-0.95), although still not significantly different for patients with severe TBI. Earlier TXA treatment (within one hour of injury) was correlated with an even more profound effect for patients with mild-moderate TBI. Lastly, TXA treatment was not associated with an increased in adverse events such as vascular occlusive event or increased disability among survivors.
Lancet 394 (10210): P1713-1723