Is tranexamic acid going to CRASH the management of traumatic brain injury?

Excerpt

In the recent CRASH-3 randomized trial [1], early (< 3 h) administration of tranexamic acid (TXA) was associated with a non-significant reduction [i.e., from 19.8 to 18.5%; relative risk, RR 0.94 (95% CI 0.86–1.02)] of head injury-related 28-day mortality in patients with isolated traumatic brain injury (TBI). However, there was a significant reduction in head injury-related mortality when TXA was administered within 3 h to patients with mild-to-moderate [from 7.5 to 5.8%, RR 0.78 (95% CI 0.64–0.95)] but not severe [from 40.1 to 39.6%, RR 0.99 (95% CI 0.91–1.07)] TBI. Major extra-cranial bleeding was an exclusion criterion, as the administration of TXA, which inhibits the enzymatic breakdown of fibrinolysis, has been proven to be effective to reduce mortality in this setting [2]. …