A low-cost and widely available drug could reduce deaths in traumatic brain injury patients by as much as 20 per cent, depending on the severity of injury, according to a major study published in The Lancet. 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, said researchers at the London School of Hygiene & Tropical Medicine in the UK.
The global randomised trial included more than 12,000 head injury patients who were given either intravenous tranexamic acid or a placebo. It found that administration of TXA within three hours of injury reduced the number of deaths, the researchers said.
This effect was greatest in patients with mild and moderate traumatic brain injury -- 20 per cent reduction in deaths -- while no clear benefit was seen in the most severely injured patients. The trial found no evidence of adverse effects and there was no increase in disability in survivors when the drug was used.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide with an estimated 69 million new cases each year, the researchers said. The CRASH-3 (Clinical Randomisation of an Antifbrinolytic 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, they said.
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 tranexamic acid 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 per cent) of TBI cases.
"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," said Ian Roberts, Professor of Clinical Trials at the London School of Hygiene & Tropical Medicine, who co-led the study, said.
"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," Roberts said.
He said that traumatic brain injury can happen to anyone at any time, whether it is through an incident like a car crash or simply falling down the stairs. "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," said Roberts.
Because TXA prevents bleeds from getting worse, but cannot undo damage already done, early treatment is critical.
The trial data showed a 10 per cent reduction in treatment effectiveness for every 20-minute delay, suggesting that patients should be treated with TXA as soon as possible after head injury.