Research at The Royal London shows promise of drug for reducing head injury deaths
A low cost and widely available drug could reduce deaths in traumatic brain injury patients by as much as 20%, depending on the severity of injury, according to a major study involving The Royal London Hospital.
The researchers say that tranexamic acid (TXA), a drug that prevents bleeding into the brain by inhibiting blood clot breakdown, has the potential to save hundreds of thousands of lives across the world.
Dr Ben Bloom, Consultant in Emergency Medicine at Barts Health NHS Trust and Senior Lecturer in Emergency Medicine at Queen Mary University of London, said: “Treating traumatic brain injury is extremely challenging with very few treatment options available for patients. Thanks to these latest results, which are applicable to patients with head injuries of any cause and of all demographics, clinicians now have a potentially powerful new treatment available to them.”
Barts Health NHS Trust was the UK’s largest recruiter into the trial with more than 500 patients enrolled, and clinicians are now looking into routinely using the drug in traumatic brain injury patients treated at The Royal London.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide with an estimated 69 million new cases each year.
Led by the London School of Hygiene & Tropical Medicine and published in The Lancet, the global trial included more than 12,000 head injury patients who were given either intravenous tranexamic acid or a placebo.
It found that administration of TXA within three hours of injury reduced the number of deaths. This effect was greatest in patients with mild and moderate traumatic brain injury (20% reduction in deaths), while no clear benefit was seen in the most severely injured patients. The trial found no evidence of adverse effects and there was no increase in disability in survivors when the drug was used.
Professor Ian Roberts from the London School of Hygiene & Tropical Medicine, who co-led the study, said: “We already know that rapid administration of tranexamic acid can save lives in patients with life threatening bleeding in the chest or abdomen such as we often see in victims of traffic crashes, shootings or stabbings. This hugely exciting new result shows that early treatment with TXA also cuts deaths from head injury. It’s an important breakthrough and the first neuroprotective drug for patients with head injury.”
Imogen Skene, Senior Clinical Research Nurse at The Royal London’s Emergency Department, said: “It’s been a privilege to have been a part of this global collaboration over the last seven years. As a major trauma centre, The Royal London has treated a significant number of patients with TBI and more than 500 patients have participated in the Crash 3 trial. I’m excited that the results show that we have a cheap, simple and effective treatment for patients with traumatic head injuries worldwide. This could be quickly implemented in to practice and save lives.”
Helen Power, Research Nurse at The Royal London’s Emergency Department, added: “It has been a privilege to be part of such a huge trial and we are proud to have contributed significantly to UK recruitment. TXA is an easy medication to administer quickly and we are really pleased that we may have a new treatment to offer our patients with traumatic head injuries.”
The authors noted some limitations of the trial, including wide confidence intervals despite the large trial size.
The trial was jointly funded by the Department for International Development (DFID), the Medical Research Council (MRC), the National Institute for Health Research (NIHR), (through the Department of Health and Social Care), and Wellcome.