Traumatic Intra-cranial 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

Research Overview

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.

Current Research

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 UK population is steadily ageing, 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.

For more:

View the CRASH-4 trial Presentation

Read the CRASH-4 trial Summary Protocol

Read the CRASH-4 trial Study Protocol

More Resources

Click on watch, read or teach to access videos, publications, and training materials 

More Treatments

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

In trauma patients with significant bleeding and those with traumatic brain injury (TBI), TXA has been  shown to reduce mortality in both extracranial and intracranial bleeding

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

GI Bleeding is a common emergency that causes substantial mortality and morbidity worldwide. TXA was found to not reduce deaths from GI bleeding and showed an increased risk of thromboembolic events

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

There is ongoing research looking at how Tranexamic Acid (TXA) could be utilised for other bleeding conditions