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Tranexamic acid for traumatic brain injury

BMJ 2011; 343 doi: (Published 01 July 2011) Cite this as: BMJ 2011;343:d3958
  1. Yvo B W E M Roos, neurologist
  1. 1Department of Neurology, H2-214, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands
  1. y.b.roos{at}

New data justify a re-evaluation in other types of intracranial haemorrhage

In July 2010 the results of the CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) study were published.1 CRASH-2 was a large placebo controlled trial that investigated the effects of early administration of a short course of the antifibrinolytic agent tranexamic acid (TXA) in 20 211 adult patients with trauma. TXA significantly reduced all cause mortality (relative risk 0.91, 95% CI 0.85 to 0.97) and the risk of death as a result of bleeding (0.85, 0.76 to 0.96). The authors concluded that TXA safely reduced the risk of death and suggested that TXA should be used in trauma patients with bleeding. However, it was unclear whether TXA could also benefit patients with traumatic brain injury because in the past TXA had been associated with cerebral ischaemia and poor outcome in patients with aneurysmal subarachnoid haemorrhage.2

In the linked study (doi:10.1136/bmj.d3795),3 the CRASH-2 collaborators present the results …

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