asked 1 week ago
Why does TXA have a contraindication of "isolated head injury" when some research (CRASH-3) has shown potential benefits in the hemorrhagic TBI populations when administered early (where pre-hospital administration would benefit pts most)?
1 Answers
answered 1 day ago
Thank you for your question. Although TXA appears to improve outcomes in injured patients with major bleeding, the effects in patients with isolated TBI are less clear. Initially it was contraindicated in CRASH-2 because TBI was not the focus of the study, but it was specifically studied in the CRASH-3 trial to see if it made a difference. The study design included brain injury (GCS<12), no major external bleeding and <3 hours from the onset of injury. Overall there was unequivocal evidence for benefit across all patients with TBI, and further research is needed to determine which patients actually do profit from TXA administration. Current literature suggests that TXA may decrease mortality in patients with mild to moderate TBI (GCS >9) but may increase mortality in patients with isolated severe TBI (GCS <9). Therefore until the evidence is more robust, TXA is contraindicated in patients with isolated TBI.
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