CRASH 3 - TXA in Traumatic Brain Injury
WYMTN Guidance
Sources:
CRASH 3 study https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext
CRASH-3 Clinical Guide v1.0 15.10.19 (Moran C, Leech C, Lecky F et al)
Following the publication of the CRASH 3 study and guidance from the National Clinical Lead for Major Trauma (Prof Chris Moran) the West Yorkshire Major Trauma Network is recommending that all constituent organisations adopt the use of TXA in Traumatic Brain Injury. The treatment algorithm suggested by the Clinical Guide published on 15.10.19 should be adopted:
Pre-hospital
• Has the patient had a head injury?
• Has the injury occurred within the last 3 hours?
• Is the GCS 12 or less?
If the answer to all three questions is yes, administer 1g TXA IV ASAP
Emergency Department
For self-presenters and for ambulance patients who have not had TXA pre-hospital for head injury:
• Has the patient had a head injury?
• Has the injury occurred within the last 3 hours?
• Is the GCS 12 or less?
If the answer to all three questions is yes, administer 1g TXA IV ASAP
There is then a second patient group with GCS 13-15:
• Does the CT scan show a TBI?
• Is it less than 3 hours since injury?
If the answer to both questions is yes, administer 1g TXA IV ASAP
In relation to paediatric patients the Clinical Guide states:
“TXA should be considered for paediatric patients with TBI. The trial did not include patients aged <16 years and therefore cannot provide any evidence of a treatment benefit in children. The findings of the CRASH-2 trial in adult patients were adapted for clinical practice in children by the Royal College of Paediatrics and Child Health using a pragmatic dosage schedule of 15mg/kg loading dose (max 1g) followed by maintenance infusion of 2mg/kg/hour (max 1g) for a maximum of eight hours…. It is for individual clinicians to decide on their approach for children.”
It should be noted that TXA should continue to be used for major trauma patients in general in line with our current guidelines (based upon CRASH 2)
Sources:
CRASH 3 study https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext
CRASH-3 Clinical Guide v1.0 15.10.19 (Moran C, Leech C, Lecky F et al)
Following the publication of the CRASH 3 study and guidance from the National Clinical Lead for Major Trauma (Prof Chris Moran) the West Yorkshire Major Trauma Network is recommending that all constituent organisations adopt the use of TXA in Traumatic Brain Injury. The treatment algorithm suggested by the Clinical Guide published on 15.10.19 should be adopted:
Pre-hospital
• Has the patient had a head injury?
• Has the injury occurred within the last 3 hours?
• Is the GCS 12 or less?
If the answer to all three questions is yes, administer 1g TXA IV ASAP
Emergency Department
For self-presenters and for ambulance patients who have not had TXA pre-hospital for head injury:
• Has the patient had a head injury?
• Has the injury occurred within the last 3 hours?
• Is the GCS 12 or less?
If the answer to all three questions is yes, administer 1g TXA IV ASAP
There is then a second patient group with GCS 13-15:
• Does the CT scan show a TBI?
• Is it less than 3 hours since injury?
If the answer to both questions is yes, administer 1g TXA IV ASAP
- TXA infusion (1g over 8 hours) should be commenced for all patients who have had TXA administered for head injury and have any TBI on CT scan
- TXA infusion should not be given (or can be stopped) in those who have a CT scan that does not demonstrate TBI
In relation to paediatric patients the Clinical Guide states:
“TXA should be considered for paediatric patients with TBI. The trial did not include patients aged <16 years and therefore cannot provide any evidence of a treatment benefit in children. The findings of the CRASH-2 trial in adult patients were adapted for clinical practice in children by the Royal College of Paediatrics and Child Health using a pragmatic dosage schedule of 15mg/kg loading dose (max 1g) followed by maintenance infusion of 2mg/kg/hour (max 1g) for a maximum of eight hours…. It is for individual clinicians to decide on their approach for children.”
It should be noted that TXA should continue to be used for major trauma patients in general in line with our current guidelines (based upon CRASH 2)