Tranexamic Acid Within Three Hours Cuts Some TBI Deaths
Patients with mild-to-moderate injury treated with tranexamic acid had reduced risk for head injury-related death
MONDAY, Oct. 21, 2019 (HealthDay News) -- Among patients with mild-to-moderate acute traumatic brain injury (TBI), the risk for head injury-related death is reduced in those receiving tranexamic acid within three hours compared with placebo, according to a study published online Oct. 14 in The Lancet.
Ian Roberts, M.D., from the London School of Hygiene & Tropical Medicine, and colleagues conducted a randomized trial in 175 hospitals in 29 countries. A total of 12,737 adult patients with TBI were randomly assigned to receive either tranexamic acid or matching placebo (6,406 and 6,331, respectively); 72.2 percent were treated within three hours of injury.
The researchers found that the risk for head injury-related death was 18.5 and 19.8 percent in the tranexamic acid and placebo groups, respectively (risk ratio, 0.94; 95 percent confidence interval, 0.86 to 1.02). The risk for head injury-related death was 12.5 and 14.0 percent in the tranexamic acid and placebo groups, respectively, in a prespecified analysis excluding patients with a Glasgow Coma Score of 3 or bilateral unreactive pupils at baseline (risk ratio, 0.89; 95 percent confidence interval, 0.80 to 1.00). In patients with mild-to-moderate injury, the risk for head injury-related death was reduced with tranexamic acid (risk ratio, 0.78; 95 percent confidence interval, 0.64 to 0.95); the risk was not reduced for patients with severe head injury (risk ratio, 0.99; 95 percent confidence interval, 0.91 to 1.07).
"The CRASH-3 trial provides evidence that tranexamic acid is safe in patients with TBI and that treatment within three hours of injury reduces head injury-related deaths," the authors write.