EBQ:CRASH-3 Trial - Revision history

Danbot: Completed journal club article: added exclusion criteria, baseline characteristics, full outcome data with RR/CI, subgroup analysis, expanded criticisms, references

2026-03-21T22:09:41Z

Completed journal club article: added exclusion criteria, baseline characteristics, full outcome data with RR/CI, subgroup analysis, expanded criticisms, references

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ElavemanMD: /* Discussion */

2019-10-29T10:14:59Z

Discussion

← Revisión anterior		Revisión del 10:14 29 oct 2019
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	==Discussion==		==Discussion==
			This trial provides evidence that administration of tranexamic acid to patients with TBI within 3 h of injury reduces head injury-related death, with no evidence of adverse effects or complications. Effect more prominent in mild and moderate head injuries compared to those with severe head injury. Anticipated that GCS 3 patients with bilateral unreactive pupils would have little potential to benefit and that inclusion may bias treatment effect towards null, which is why there was a prespecified subgroup.

	===Criticism===		===Criticism===
			There remains a possibility of undersensing adverse events such as thrombotic event due to requirement of a diagnostic test confirming presence of the thrombotic event.

	==Funding==		==Funding==

ElavemanMD: /* Interventions */

2019-10-29T10:07:47Z

Interventions

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	==Interventions==		==Interventions==
	Loading dose 1 g over 10 min ~~then~~ infusion of 1g over 8 hours		Loading dose 1 g over 10 min followed by infusion of 1g over 8 hours

	==Outcomes/Results==		==Outcomes/Results==

ElavemanMD at 10:07, 29 October 2019

2019-10-29T10:07:05Z

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	==Clinical Question==		==Clinical Question==
	'''Is tranexamic acid beneficial in patients with TBI?'''		'''Is [[tranexamic acid]] beneficial in patients with TBI?'''

	==Conclusion==		==Conclusion==
	'''"Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury"'''		'''"Our results show that [[tranexamic acid]] is safe in patients with TBI and that treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury"'''

	~~==Major Points==~~		[[Intracranial hemorrhage (main)\|Intracranial Hemorrhage]]
	{{Intracranial hemorrhage ~~DDX}}~~
	~~{{ICH Hypertension Guidelines}}~~
	~~{{ICH Coagulopathy Guidelines}}~~

	==Design==		==Design==

ElavemanMD: /* Major Points */

2019-10-29T10:05:35Z

Major Points

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	==Major Points==		==Major Points==
	{{Intracranial ~~Hemorrhage (Main)~~}}		{{Intracranial hemorrhage DDX}}
			{{ICH Hypertension Guidelines}}
			{{ICH Coagulopathy Guidelines}}

	==Design==		==Design==

ElavemanMD at 10:03, 29 October 2019

2019-10-29T10:03:32Z

← Revisión anterior		Revisión del 10:03 29 oct 2019
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	\| journal=The Lancet		\| journal=The Lancet
	\| year=2019		\| year=2019
			\| volume na
			\| issues na
			\| pages na
	\| pmid= 31623894		\| pmid= 31623894
	\| fulltexturl=http://doi.org/10.1016/S0140-6736(19)32233-0		\| fulltexturl=http://doi.org/10.1016/S0140-6736(19)32233-0
Línea 18:		Línea 21:

	==Major Points==		==Major Points==
	{{Intracranial Hemorrhage}}		{{Intracranial Hemorrhage (Main)}}

	==Design==		==Design==
			*Randomized, placebo controlled trial of 12,737 patients done in 175 hospitals in 29 countries on patients with TBI.

	==Population Studied==		==Population Studied==
	===Inclusion Criteria===		===Inclusion Criteria===
	*		*Adults with TBI were within 3 hours of injury, GCS 12 or lower or any intracranial bleeding on CT scan.

	===Exclusion Criteria===		===Exclusion Criteria===
	*

	===Baseline Characteristics===		===Baseline Characteristics===
	*		*80% men, 19% female
			*Mean age 41.7 years
			*Bilateral nonreactive pupils 9%

	==Interventions==		==Interventions==
			Loading dose 1 g over 10 min then infusion of 1g over 8 hours

	==Outcomes==		==Outcomes/Results==
	===Primary Outcomes===		===Primary Outcomes===
			Head injury-related death in hospital within 28 days of injury
			*Among patients treated within 3 hours of injury, risk of head injury-related death was 18.5% in TXA group versus 19.8% in placebo group (CI 0.86-1.02).

			Prespecified sensitivity analysis that excluded patients with a GCS of 3 and those with bilateral unreactive pupils at baseline
			*There was a 12.5% risk of head injury related death compared to 14% in placebo (CI 0.80-1.00)

	===Secondary Outcomes===		===Secondary Outcomes===
	*		*Early head injury-related death (within 24 h after injury)
			*All-cause and cause-specific mortality
			*Disability
			*Vascular occlusive events (MI, CVA, DVT, PE) - Similar in TXA vs. placebo
			*Seizures
			*complications
			*Neurosurgery days in ICU
			*Adverse events within 28 days

	====Adverse events====		====Adverse events====
	*

	~~==Tertiary Outcomes==~~

ElavemanMD: Created page with "{{JC info | title=Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a r..."

2019-10-29T08:53:17Z

Created page with "{{JC info | title=Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a r..."

Página nueva

{{JC info
| title=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.
| abbreviation=CRASH-3
| published=2019-14-10
| author=The Crash 3 Trial Collaborators
| journal=The Lancet
| year=2019
| pmid= 31623894
| fulltexturl=http://doi.org/10.1016/S0140-6736(19)32233-0
| status = Incomplete
}}

==Clinical Question==
'''Is tranexamic acid beneficial in patients with TBI?'''

==Conclusion==
'''"Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury"'''

==Major Points==
{{Intracranial Hemorrhage}}

==Design==

==Population Studied==
===Inclusion Criteria===
*

===Exclusion Criteria===
*

===Baseline Characteristics===
*

==Interventions==

==Outcomes==
===Primary Outcomes===

===Secondary Outcomes===
*

====Adverse events====
*

==Tertiary Outcomes==

==Discussion==

===Criticism===

==Funding==
National institute for health research health technology assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Welcome Trust (Joint Global Health Trials Scheme)

==See Also==