Traumatic Intra-Cranial Bleeding

Worldwide at least 200 per 100,000 people are killed or admitted to hospital each year after traumatic brain injury. This results in more than 10 million deaths or hospitalisations each year.Traumatic brain injuries are the leading cause of death and disability in people below the age of 45.

Traumatic brain injury patients can experience a loss in physical, behavioural or emotional functioning after the injury. Severe traumatic brain injury often results in motor impairment that persists for at least three years after the injury and cognitive impairments are present for at least six months after injury. Problems with memory following traumatic brain injury significantly affect an individual’s quality of life. Even with rehabilitation treatments, only 40-50% of patients recover completely.

The increasing incidence of traumatic brain injury can be explained by the rising frequency of traffic accidents in developing countries and rapidly motorizing middle-income countries. Falls in older adults are the leading cause of traumatic brain injury in high-income countries. Given the global scope of this life threatening and potentially disabling condition, it is important to identify the most effective clinical care in this patient group.

Intracranial bleeding is common after traumatic brain injury, and the larger the bleed the greater the risk of death and disability. Although bleeding can continue for around 24 hours after injury, most bleeds stop progressing within a few hours of hospital admission. The majority of the increase in bleeding occurs within a few hours of injury. Tranexamic acid is able to penetrate the blood-brain barrier and should be able to affect intracranial haemorrhage.

Current Research

The CRASH-3 trial is an international, randomized, double-blind, placebo-controlled trial to quantify the effects of early tranexamic acid administration on death and disability in patients with traumatic brain injury. About 13,000 patients who fulfil the eligibility criteria will be randomly allocated to receive tranexamic acid or placebo. The results from this trial should provide clinicians with information about whether tranexamic is effective in reducing death and disability. The trial will also provide information about whether the effect of tranexamic acid varies by time to treatment. The trial is on-going and results are expected in 2018.

Resources

All Videos

23. 03. 2017

Time is Brain – randomise and treat urgently

In this video Professor of Trauma Neurosurgery, Antonio Belli emphasises the need to randomise and treat patients as early as possible after the injury in order to prevent further damage to the brain

05. 03. 2017

Scientific rationale for the CRASH-3 trial

Prof Ian Roberts explains why we are doing the CRASH-3 trial

04. 07. 2017

CRASH-3 trial training video

This video describes the trial procedures of the CRASH-3 trial, an international, randomized, double-blind, placebo-controlled trial to quantify the effects of early tranexamic acid administration on death and disability in patients with traumatic brain injury.

More Treatments