Skull fractures

Tranexamic acid

One large randomized control trial (12,737 patients) showed a reduction in mortality in patients with mild-to-moderate head injury (baseline Glasgow Coma Scale 9-15) who were treated with tranexamic acid (an antifibrinolytic agent) within 3 hours of injury, compared with those who were not.[83]CRASH-3 trial collaborators. 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. Lancet. 2019 Nov 9;394(10210):1713-23. https://www.doi.org/10.1016/S0140-6736(19)32233-0 http://www.ncbi.nlm.nih.gov/pubmed/31623894?tool=bestpractice.com However, its results should be interpreted with some caution due to: significance only in the subgroup analysis; change in recruitment (from within 8 to within 3 hours of injury); change in primary outcome (from all-cause to disease-specific mortality); and the risk of selection and observer bias. One randomized controlled trial published in 2020 (N=1280, 20 centers and 39 emergency medical services agencies in the US and Canada) compared tranexamic acid with placebo within 2 hours of moderate or severe traumatic brain injury.[84]Rowell SE, Meier EN, McKnight B, et al. Effect of out-of-hospital tranexamic acid vs placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA. 2020 Sep 8;324(10):961-74. https://jamanetwork.com/journals/jama/fullarticle/2770409 http://www.ncbi.nlm.nih.gov/pubmed/32897344?tool=bestpractice.com A favorable functional neurologic outcome (measured as Glasgow Outcome Scale-Extended >4 at 6 months) occurred in 65% of patients in the tranexamic acid groups versus 62% with placebo. There was no statistically significant difference in all-cause 28-day mortality, Disability Rating Scale score at 6 months, or progression of intracranial hemorrhage.