Potential of simple injection on patients with head injury

The CRASH-2 Intracranial Bleeding Study highlighting the potential of the cheap, off-patent drug to help people suffering from brain trauma is published online by the British Medical Journal.

According to the collaborators -- led by the London School of Hygiene & Tropical Medicine -- the results provide strong grounds to test the effect of this treatment in a larger and definitive study. The forthcoming CRASH-3 trial will determine reliably the effectiveness of tranexamic acid in patients with head injury.

Every year millions of people world-wide are treated for head injury. Unfortunately, currently there is no proven effective treatment for this life threatening condition, which affects mainly young working people. One of the frequent complications occurring after head injury is bleeding into the head. Usually this bleeding progresses in the first hours after the injury and produces more brain damage. Because tranexamic acid reduces clot breakdown the investigators hypothesised that this drug could reduce bleeding into the brain and therefore improve patients' outcomes.

The CRASH-2 Intracranial Bleeding Study was the first to evaluate the effect of tranexamic acid on head injury patients. The results showed that patients who receive tranexamic acid were less likely to have bleeding progression, they survive more and with less disability.

Dr Pablo Perel, who is based in the Clinical Trials Unit at LSHTM, says: "Although the results are not definitive they provide hope about the potential effectiveness of this simple drug for head injury patients. If such an inexpensive and widely practicable treatment were found to improve patient outcomes after head injury this would have major implications for clinical care."

Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study) BMJ 2011;342:d3795 doi: 10.1136/bmj.d3795

The study involved 270 adult trauma patients with, or at risk of, significant extracranial bleeding within 8 hours of injury, who also had traumatic brain injury. It was a prospective randomised controlled trial carried out within the larger CRASH-2 trial to quantify the effect of an early short course of tranexamic acid on intracranial haemorrhage.

In May 2011, the CRASH-2 trial collaborators' paper: Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010: doi:10.1016/S0140-6736(10)60835-5 was named Research Paper of the Year in the BMJ Group Awards.