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Which one of the following statements is most true with regard to the administration of intravenous tranexamic acid following traumatic head injury?

(Please select 1 option)

Administration reduces the incidence of long-term neurological deficit Incorrect answer selected

Is only indicated if the Glasgow Coma Score is less than 9

It is contraindicated because there is an increased risk of post-injury thrombotic stroke

The incidence of mortality is reduced at all levels of severity of traumatic head injury

The first dose should be administered within 3-hours of the injury This is the correct answer

Explanation

The CRASH-3 trial was an international randomised placebo-controlled multicentre trial investigating the effects of the administration of 1g of intravenous tranexamic acid (TXA) to adults within 3-hours of a traumatic brain injury. Other criteria included a Glasgow Coma Score of 12 or less and evidence of intracranial bleeding on a CT scan.

Patients were randomly allocated to receive a loading dose of 1g of TXA infused over 10 min, started immediately after randomisation, followed by an intravenous infusion of 1g over 8-hours, or a placebo.

The results showed a reduction in the risk of head injury-related death in patients with mild to moderate head injury. This was not the case for severe head injured patients. Early treatment was more effective than later treatment in patients with mild and moderate head injury (p=0·005). Primary outcome was death and secondary outcomes included (confined to bed, ability to wash and dress, pain and discomfort, anxiety and depression, severe agitation and depression, severe fatigue) these descriptors were used to calculate disability rating scores. There were no significant differences in disability scores between the TXA and placebo groups with mild and moderate head injury.

There was no evidence of any increased risk of adverse events including the risk of deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction.

Reference:

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The CRASH-3 trial collaborators. Published Online October 14, 2019

Answer Statistics

1

7%

2

3%

3

8%

4

14%

5

70%

Times answered: 221