A CRASH-3 Trial Sub-Study Provides Evidence of TXA Benefit in TBI

The CRASH-3 trial results showed evidence that Tranexamic Acid (TXA) can help prevent premature death from isolated Traumatic Brain Injury (TBI), a huge global health problem, and a worldwide killer of millions of people every year.

While the CRASH-3 trial was underway, the Data Monitoring Committee asked for additional CT scan data to be collected ‘to explore if, why, and how patients are affected by TXA’.

Consequently, a separate sub-study protocol was developed.

So, during the CRASH-3 trial, and before the results were unblinded, brain scans acquired as part of routine clinical practice from a sample of CRASH-3 trial patients were examined.

If patients who received TXA have less intracranial bleeding or more cerebral infarction on their scans compared with those who receive placebo, this information, along with the results of the main CRASH-3 trial, could improve understanding of the mechanism of action of TXA and help generalise the CRASH-3 trial results.

This sub-study found that when patients with unreactive pupils at baseline were excluded, there was evidence that TXA prevents new haemorrhage (adjusted RR=0.80, 95% CI 0.66 to 0.98).  This is consistent with the results of the CRASH-3 trial, which found that TXA reduced head injury death in patients with at least one reactive pupil at baseline.

TXA must be administered as soon as possible from when an injury occurs. Every 15 minutes treatment is delayed the survival benefit from TXA drops by 10%.

Read the full article published in Emergency Medicine Journal HERE.