The CRASH-4 trial aims to provide reliable evidence about the effects of early intramuscular TXA on intracranial haemorrhage, disability, death and dementia in older adults with symptomatic head injury.
Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. Results from randomised trials (CRASH-3 and NCT01990768) show that early treatment with TXA reduces head injury deaths (pooled RR 0.89, 95% CI 0.80-0.99).
In the CRASH-3 trial, the reduction in head injury deaths with TXA was largest in patients with mild and moderate head injuries, particularly if patients were treated soon after injury.
However, the CRASH-3 trial included mild TBI patients only if they had intracranial bleeding on CT scan.