CRASH-3 Trial: Tranexamic Acid in Mild-Moderate Head Injury

CRASH-3 Trial examined the effect of tranexamic acid on head injury-related death in 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.

The results indicated a reduction in the risk of head injury-related death with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64–0·95]) but in patients with severe head injury (0·99 [0·91–1·07]) there was no clear evidence of a reduction (p value for heterogeneity 0·030).

The effect of tranexamic acid on head injury-related death stratified by time to treatment and recorded no evidence of heterogeneity (p=0·96). The RR of head injury-related death with tranexamic acid was 0·96 (95% CI 0·79–1·17) in patients randomly assigned within 1 h of injury, 0·93 (0·85–1·02) in those randomly assigned within more than 1 h and 3 h or fewer after injury, and 0·94 (0·81–1·09) in those randomly assigned more than 3 h after injury.

Tranexamic Acid in PPH – WOMAN Trial

Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008).

Tranexamic Acid for Severe Trauma – CRASH-2 Trial

Tranexamic acid (1g given over 10 min (IVI) followed by 1g given over 8h (IVI)) can save 1 in 67 patients with severe trauma

CRASH-2: A large multicenter randomised control trial of 20,211 patients (CRASH2) found:

The most severely injured patients who received TXA had the highest reduction in mortality. Benefits were greatest for those treated within 3 hours of injury and subgroup analysis demonstrated that TXA was most effective in patients with shock (systolic blood pressure < 75 mmHg).