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The CRASH3 study: prehospital TXA for every injured patient?

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journal contribution
posted on 15.04.2020, 10:15 by Timothy J. Coats, Fiona E. Lecky
The CRASH3 results are out, but do we know what to do? The study enrolled 9202 head injured patients within 3 hours of injury with a Glasgow Coma Scale (GCS) of 12 or less, or any intracranial bleeding on CT scan and randomised them to Tranexamic Acid (TXA) or placebo. The relative risk (RR) of all-cause mortality (RR 0.96, 95% CI 0.89-1.04) and head injury death (RR 0.94, 95% CI 086-1.02) among those receiving TXA were not significant. However there were significant differences in subgroups who were less severely injured (RR 0.89 95%CI 0.80-1.00 if those with GCS=3 or bilateral fixed pupils were excluded, and RR 0.78, 95% CI 0.64 to 0.95, in the GCS 9 to 15 subgroup) or treated earlier (p=0.005 for time effect)[1].

The results need to be considered in the context of earlier CRASH2[2] results, which showed a reduction in all-cause mortality (RR 0.91, 0.85 to 0.97) and death due to bleeding (RR 0.85, 0.76-0.96) if trauma patients who were bleeding or at risk of bleeding were given TXA. In both CRASH2 and CRASH3 the TXA was given in the emergency department.

History

Citation

Emergency Medicine Journal 2020

Author affiliation

Emergency Medicine Academic Group (EMAG), College of Medicine Biological Sciences and Psychology

Version

AM (Accepted Manuscript)

Published in

Emergency medicine journal : EMJ

Publisher

BMJ

issn

1472-0205

eissn

1472-0213

Acceptance date

07/03/2020

Copyright date

2020

Available date

27/03/2020

Publisher version

https://emj.bmj.com/content/early/2020/04/07/emermed-2019-209264

Spatial coverage

England

Language

eng

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