Deepening our understanding of the mechanism of action of tranexamic acid in TBI

Tranexamic acid prevents blood clots from breaking down and reduces bleeding. However, its role in traumatic brain injury remains uncertain. The CRASH-3 trial is a randomised trial that will examine the effect of tranexamic acid (versus placebo) on death and disability in 13,000 patients with traumatic brain injury. We hope that tranexamic acid will reduce the extent of intracranial haemorrhage and in this way reduce the risk of death. However, there is also a potential for harm. In particular, tranexamic acid may increase the risk of cerebral thrombosis and ischaemia. To deepen our understanding of the risks and benefits of tranexamic acid in traumatic brain injury, a mechanistic study is being conducted alongside the CRASH-3 trial. The study will examine CT scans of patients enrolled in the CRASH-3 trial to assess the effect of tranexamic acid on intracranial bleeding and cerebral ischaemia. The lead researcher is Abda Mahmood from the London School of Hygiene & Tropical Medicine. The study protocol was recently published: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2073-6