In the recent CRASH-3 randomized trial, early administration of tranexamic acid (TXA) was associated with a non-significant reduction 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 but not severe 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.

The trial has been an impressive endeavor, with almost 13,000 patients randomized in 175 hospitals from 29 countries.

A large proportion of patients was included in low- or middle-income countries, where TBI represents an increasing burden and trials are rarely performed.

The rate of follow-up was also incredibly high, with information on the primary outcome being available for 99.2% of patients.

Read More