Effects of Tranexamic Acid on Death, Disability, and Vascular Occlusive Events in Traumatic Brain Injury
Lancet, 2019 · International multicenter randomized double-blind placebo-controlled trial (n=12,737)
Clinical question
Does early tranexamic acid reduce head injury-related mortality in patients with acute traumatic brain injury?
What the trial found
Early tranexamic acid administration within 3 hours reduces head injury mortality in mild-to-moderate TBI without increasing thromboembolic risk.
Current guideline position
Incorporated into international trauma and neurotrauma resuscitation algorithms.
Clinical interpretation
Supports early TXA for non-severe TBI presenting within 3 hours of injury.
Severe TBI neurocritical care: prevent hypoxemia/hypotension, treat intracranial hypertension, individualize ventilation/CPP, use evidence-based short antiseizure prophylaxis when chosen, and escalate surgery when indicated.
The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.