Tranexamic acid against TBI
An inexpensive way to save patients with traumatic brain injury
Sergey Syrov, XX2 century
Craniocerebral trauma is mechanical damage to the skull and (or) intracranial formations (brain, meninges, vessels, cranial nerves). It accounts for 25-30% of all injuries, and among the fatal outcomes of injuries, its specific weight reaches 50-60%. As a cause of mortality in young and middle-aged people, TBI is ahead of cardiovascular and oncological diseases.
The Lancet has published an article reporting the results of a major study aimed at improving the treatment protocol for patients with traumatic brain injuries. It turned out that tranexamic acid, administered within the first three hours after injury, reduces the mortality of patients.
The therapeutic effect was strongest for patients with mild to moderate traumatic brain injuries - and this means a reduction in mortality by as much as 20%, depending on the severity of the injury. But the drug is not a panacea – there was no obvious benefit from its use for severely affected patients. During the study, no signs of undesirable side effects were recorded, and there was no increase in disability among survivors.
About 69 million traumatic brain injuries are registered annually. To improve the treatment protocol, a study was conducted called CRASH ("talking" abbreviation for Clinical Randomization of an Antifibrinolytic in Significant Head Injury, clinical randomization of an antifibrinolytic drug in significant head injury) – one of the largest trials ever conducted in the field of emergency care for head injury. Patients were recruited in 175 hospitals from 29 countries.
Bleeding in or near the brain due to rupture of blood vessels is a common complication of traumatic brain injury. Often it ends in death. Although severely injured patients will not benefit from treatment with tranexamic acid, but it will help many, because more than 90% of cases of TBI occur in cases of mild and moderate severity.
Ian Roberts, Professor of Clinical Trials at the London School of Hygiene & Tropical Medicine, co-author of the study:
"We already know that rapid administration of tranexamic acid can save the lives of patients with life-threatening bleeding in the chest or abdomen, such as we often see in victims of road accidents, shootings or stab wounds. A new, extremely exciting result shows that early treatment with tranexamic acid also reduces mortality from head injury. This is an important breakthrough – the first neuroprotective drug for patients with head trauma.
A traumatic brain injury can happen to anyone at any time, whether it's due to an incident like a car accident or a simple fall down the stairs. We believe that if our methods are widely implemented, they will increase the chances of people who have experienced head trauma, both in high- and low-income countries around the world."
Since the studied drug prevents bleeding, but cannot undo the damage already done, a quick start of treatment is crucial. These studies have shown a 10% decrease in the effectiveness of therapy for every 20-minute delay, which suggests that patients should receive medication as soon as possible after injury.
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