TXA in severe head injury

JC: TXA in severe head injury

St Emlyn’s - By Simon Carley - September 13, 2020

“ Our post on the CRASH-3 trial, an RCT examining the use of TXA in head injury, was arguably our most controversial of 2019. Our view was that the evidence was not entirely definitive, but on the balance of probabilities TXA should be given to patients with moderate head injury, although it was probably of little use amongst those who had severe injury.
We are of course always open to the opportunity to change our views and therefore it’s good to see another RCT of TXA in head injury published in JAMA...

The bottom line.

• The evidence for or against TXA in head injury remains uncertain. On the balance of probabilities my view remains unchanged from our previous CRASH3 conclusions.
• TXA has been shown to reduce bleeding related deaths in a variety of settings suggesting that it fundamentally improves outcomes for patients with life threatening bleeding.
• TXA should be given to all mild/moderate head injured patients with evidence of bleeding on CT scan.
• TXA should be given to all patients who have bilaterally reactive pupils and blood on CT scan.
• Patients with head injury PLUS extra-cranial injury TXA should be given to patients within 3 hours.“