The MRC CRASH-3 trial evaluated tranexamic acid in traumatic brain injury. What was the primary finding regarding timing of administration?
- A TXA has no benefit in any category of TBI regardless of timing
- B TXA reduces head injury mortality when given within 3 hours in mild-moderate TBI ✓
- C TXA reduces mortality only in severe TBI (GCS <9)
- D TXA reduces mortality only when given within 30 minutes of injury
Explanation
The CRASH-3 trial (Lancet 2019, n=12,737) showed that tranexamic acid (loading dose 1g over 10 min, then 1g over 8 hours IV) reduced head injury deaths when given within 3 hours of injury, with the greatest benefit in mild-moderate TBI (GCS 9–15). In patients with GCS 3 or bilateral unreactive pupils (severe TBI), no significant mortality benefit was demonstrated — suggesting irreversible injury in the most severely injured. The earlier TXA was given within the 3-hour window, the greater the benefit. This has been incorporated into many TBI management protocols worldwide.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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