TXA Central is a resource for health professionals caring for patients with acute severe bleeding
Worldwide, over 10 million people are killed or hospitalised because of
Traumatic Brain Injury (TBI) each year
Whether that be through a sports injury, a trip or fall, or a road traffic crash, TBI can have devastating consequences for the people affected
Tranexamic Acid (TXA) for TBI
Bleeding into the brain, or intracranial haemorrhage is common following a head injury. As the volume of blood increases, it exerts pressure inside the skull. If the bleeding continues and the pressure continues to rise, compression of the brain leads to oxygen deprivation, brain herniation, and death.
TBI patients can experience a loss in physical, behavioural, or emotional functioning after the injury. Even with rehabilitation, only 40-50% of patients recover completely.
The CRASH-3 trial was an international, multicenter, randomised, placebo-controlled trial of the effects of tranexamic acid (TXA) on death and disability in patients with TBI.
This international trial recruited 12 ,737 TBI patients from 175 hospitals in 29 countries.
Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding was eligible. Once recruited the patients received 1g TXA as a bolus and then an 8-hour infusion of 1g of TXA.
This trial provides evidence that the administration of TXA to patients with TBI within 3h of injury reduces head injury-related death, with no evidence of adverse effects or complications.
A substantial reduction in head injury-related deaths with TXA in patients with mild and moderate head injuries was found but no apparent reduction in those with severe head injury. There was no found increase in disability among survivors.
The CRASH-4 Pilot Trial
A fall from standing height in older adults is the commonest cause of major trauma in the UK.
Traumatic brain injury accounts for half of the trauma admissions in older adults and is a leading cause of death and disability.
Because the population aged over 70 years is increasing, the number of older adults with TBI will continue to rise.
Most (90%) of the 1.4 million TBI patients seen each year in emergency departments in England and Wales have mild (Glasgow Coma Scale (GCS) score 13-15) head injury, but the term ‘mild’ is misleading in older adults who have higher death rates and worse outcomes than younger patients.
Due to increased use of anticoagulant and antiplatelet drugs, older adults are more likely to suffer intracranial bleeding after mild TBI. TBI is also a strong risk factor for dementia in older adults.
The CRASH-4 trial aims to provide reliable evidence about the effects of early intramuscular TXA on intracranial haemorrhage, disability, death, and dementia in older adults with symptomatic head injury.
View the CRASH-4 trial Presentation
Read the CRASH-4 trial Summary Protocol
Read the CRASH-4 trial Protocol Study
Click on watch, read or teach to access videos, publications, and training materials
CRASH-3 Trial Results
The CRASH-3 trial results show that TXA can help prevent premature death from isolated TBI, a huge global health problem and worldwide killer of thousands. TXA is safe, low cost, and widely available
CRASH-3: The World’s first effective drug for TBI
With an estimated 69 million cases per year, a figure that’s only expected to rise, thanks to CRASH-3 trial we know now that TXA can be used to prevent premature death and disability from TBI
CRASH-3: World Congress on Intensive Care
Prof Ian Roberts talk explains the significance of the results at the World Congress on Intensive Care
CRASH-3: Trial Results Presented by Professor Ian Roberts
Prof Ian Roberts talks about the trial results, benefits of TXA, and what it means for emergency care in trauma patients worldwide
CRASH-3: Trial Procedure 1
How patients were collected and assessed
CRASH-3: Trial Procedure 2
CRASH-3: Estimating Time of Injury
Professor Ian Roberts explains the importance of accurately estimating the time of injury in the CRASH-3 trial
CRASH-3: Randomisation Rhyme – Time is Brain
A poem highlighting the importance of randomising and treating patients as early as possible to prevent further brain damage
CRASH-3: A Doctors Story
A doctor describes a personal experience of TBI and the need to administer TXA treatment as soon as possible after injury
CRASH-3: Time Is Brain
Professor of Trauma Neurosurgery, Antonio Belli emphasises the need to randomise and treat patients as early as possible in order to prevent further damage to the brain
CRASH-3: Trial Results
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
CRASH-3: Study Protocol
CRASH-3 – Tranexamic Acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial
CRASH-3: Intracranial Bleeding Study
Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo-controlled trial (CRASH-2 intracranial bleeding study)
Does tranexamic acid improve outcomes in traumatic brain injury?
CRASH-3: A Pre-planned Substudy of sample CRASH-3 trial patients
Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: a pre-planned substudy in a sample of CRASH-3 trial patients
CRASH-3: Neuroprotective Effect of TXA
Understanding the neuroprotective effect of tranexamic acid: an exploratory analysis of the CRASH-3 randomised trial
CRASH-3: Accuracy of Time to Treatment
Accuracy of time to treatment estimates in the CRASH-3 clinical trial: impact on the trial results
CRASH-3: Cost-effectiveness analysis of TXA for the treatment of traumatic brain injury
Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach
CRASH-3: Tranexamic Acid for Traumatic Brain Injury – Authors reply
CRASH-3: TXA for bleeding trauma patients
Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study
CRASH-3: An Intracranial Bleeding Mechanistic Study
A nested randomised trial of the effect of tranexamic acid on intracranial haemorrhage and infarction in traumatic brain injury
Outcome measures in clinical trials of treatments for acute severe haemorrhage
CRASH-3: Intracranial Bleeding Mechanistic Sub-Study
A nested mechanistic sub-study into the effect of tranexamic acid versus placebo on intracranial haemorrhage and cerebral ischaemia in isolated traumatic brain injury: study protocol for a randomised controlled trial
CRASH-3: Differential effects of the Glasgow Coma Scale Score and its Components
An analysis of 54,069 patients with traumatic brain injury
CRASH-3: Exploration of Benefits and Harms
Tranexamic acid in bleeding trauma patients: an exploration of benefits and harms
CRASH-3: Does tranexamic acid improve outcomes in traumatic brain injury?
CRASH-3: An Exploratory Analysis of Data from CRASH-2
Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH-2 trial
CRASH-3: TXA in Trauma Patients
Applying results from clinical trials: tranexamic acid in trauma patients
CRASH-3: Red Blood Cell Transfusion & Mortality
Red blood cell transfusion and mortality in trauma patients: risk-stratified analysis of an observational study
CRASH-3 Trial: Background Rationale & Overview
CRASH-3 Trial: Protocol
A randomised, double-blind placebo-controlled trial among 13,000 traumatic brain injury patients
CRASH-3: Statistical Analysis Plan
Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial
CRASH-3 Trial: Why urgent randomisation and treatment is critical
TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website
Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding
Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain