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Widely available drug may reduce head injury deaths

Early treatment with tranexamic acid could save many lives

Adrian O'Dowd

Tuesday, 15 October 2019

A cheap and widely available drug could reduce deaths in traumatic brain injury patients by as much as 20% depending on the severity of injury, suggests a new study* published in The Lancet.

The researchers said that tranexamic acid (TXA) – a drug that prevents bleeding into the brain by inhibiting blood clot breakdown – has the potential to save hundreds of thousands of lives.

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide with an estimated 69 million new cases each year. Bleeding in or around the brain due to tearing of blood vessels is a common complication of TBI and can lead to brain compression and death.

The CRASH-3 (Clinical Randomisation of an Antifbrinolytic in Significant Head Injury) trial was one of the largest clinical trials ever conducted into head injury. Patients were recruited from 175 hospitals across 29 countries.

The trial, led by the London School of Hygiene & Tropical Medicine, included 12,737 head injury patients who were given either intravenous tranexamic acid or a placebo.

Results showed that administering TXA within three hours of injury reduced the number of deaths.

This effect was greatest in patients with mild and moderate traumatic brain injury (20% reduction in deaths), while no clear benefit was seen in the most severely injured patients probably because patients with very severe head injuries often have extensive brain bleeding prior to hospital admission and treatment.

The trial found no evidence of adverse effects and there was no increase in disability in survivors when the drug was used.

Ian Roberts, professor of clinical trials at the London School of Hygiene & Tropical Medicine, who co-led the study, said: “We already know that rapid administration of tranexamic acid can save lives in patients with life threatening bleeding in the chest or abdomen such as we often see in victims of traffic crashes, shootings or stabbings.

“This hugely exciting new result shows that early treatment with TXA also cuts deaths from head injury. It’s an important breakthrough and the first neuroprotective drug for patients with head injury.

“We believe that if our findings are widely implemented they will boost the chances of people surviving head injuries in both high income and low income countries around the world.”

Because TXA prevents bleeds from getting worse, but cannot undo damage already done, early treatment is critical and the trial data also showed a 10% reduction in treatment effectiveness for every 20-minute delay, suggesting patients should be treated with TXA as soon as possible after head injury.

Antoni Belli, neurosurgeon and professor of trauma neurosurgery at the University of Birmingham and co-investigator for the trial, said: “After decades of research and many unsuccessful attempts, this is the first ever clinical trial to show that a drug can reduce mortality after traumatic brain injury.

“Not only do we think this could save hundreds of thousands of lives worldwide, but it will no doubt renew the enthusiasm for drug discovery research for this devastating condition.”

Dr Ben Bloom, consultant in emergency medicine at Barts Health NHS Trust, the UK’s largest recruiter into the trial with more than 500 patients enrolled, said: “Treating traumatic brain injury is extremely challenging with very few treatment options available for patients.

“Thanks to these latest results, which are applicable to patients with head injuries of any cause and of all demographics, clinicians now have a potentially powerful new treatment available to them.”

*The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet. DOI:10.1016/ S0140-6736(19)32233-0. 

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