London School of Hygiene & Tropical Medicine Lead CRASH-3 Trial Evidencing Widely Available Drug Reduces Head Injury Deaths

London School of Hygiene & Tropical Medicine Lead CRASH-3 Trial Evidencing Widely Available Drug Reduces Head Injury Deaths

The London School of Hygiene & Tropical Medicine recently led the CRASH-3 clinical trial evidencing that a widely available drug called tranexamic acid (TXA) could save tens of thousands of lives.

Published recently in The Lancet, the investigators believe the drug could reduce deaths in traumatic brain injury patients by as much as 20%, depending on the severity of the injury as reported in the university’s press release.

Traumatic Brain Injury (TBI)

TBI is a leading cause of death and disability worldwide with an estimated $69 million new cases per year according to a multinational study in 2018

CRASH-3 Trial

The CRASH-3 (Clinical Randomization of an Antifibrinolytic in Significant Head Injury) trial is one of the largest clinical trials ever conducted into head injury. Patients were recruited from 175 hospitals across 29 countries. The global randomized trial included more than 12,000 head injury patients who were given either intravenous tranexamic acid or a placebo. It found that the administration of TXA within three hours of injury reduced the number of deaths. The effect was greatest in patients with mild and moderate traumatic brain injury (20% reduction in deaths) reported the study lead site London School of Hygiene & Tropical Medicine. 

The researchers found no evidence of adverse effects and no increase in disability in survivors when the drug was used—they found that the treatment didn’t have any clear effect on the most severely injured patients.

The Drug

Tranexamic acid (TXA) is a medication to prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removals, nosebleeds, and heavy menstruation. It was first made in 1962 by Japanese researchers Shosuke and Utako Okamoto. It is available as a generic medicine and extremely affordable.

The Science

The university reports that 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. Although patients with very severe head injuries are unlikely to benefit from TXA treatment because they often have extensive brain bleeding prior to hospital admission and treatment, the study found a substantial benefit in patients with less severe injuries who comprise the majority (over 90%) of TBI cases.

Principal Investigator

Ian Roberts, a Professor of Clinical Trials at the London School of Hygiene & Tropical Medicine, who co-led the study and noted “We already know that rapid administration of tranexamic acid can save lives in patients with life-threatening to bleed in the chest or abdomen such as we often see in victims of traffic crashes, shootings or stabbings. This hugely existing new result shows that early treatment with TXA also cuts deaths from a head injury. It’s an important breakthrough and the first neuroprotective drug for patients with a head injury.” Follow the link to the source to watch the broadcast video of this story.

Other prominent participating investigators included Antoni Belli, Neurosurgeon and Professor of Trauma Neurosurgery at the University of Birmingham and co-investigator for the trial as well as Dr. Ben Bloom, Consultant in Emergency Medicine at Barts Health NHS TrustCall to Action: It would appear that the implications are big for this study. TXA, a widely available, low-cost drug could be used for mild to moderate head injuries which could potentially save tens of thousands of lives.