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Tranexamic acid to stop brain bleeds could save thousands of lives

DRUG TO STOP BRAIN BLEEDS COULD SAVE THOUSANDS OF LIVES (Times Newspaper 15/10/19)

Thousands of lives could be saved worldwide every year after scientists showed for the first time that a drug can reduce mortality after traumatic brain injury.

The treatment, Tranexamic Acid, works to prevent bleeding in the brain ans so arrest the damage that can continue after the initial injury. The drug has been approved for clinical use and is routinely taken to prevent internal bleeding elsewhere in the body after trauma. The research shows that it could also be used to improve outcomes after brain injury, which remains the main cause of death and disability among people under the age of 40 in Britain.

There are an estimated 60 million cases of traumatic brain injury globally every year, including about 150,000 admitted to hospital in Britain. Many are the results of road traffic accidents.

In a study of almost 13,000 patients in 175 hospitals across 29 countries, scientists showed that swiftly administering tranexamic acid (TXA) could lead to small but significant improvements. In the study 14 percent who took a placebo had a head related death. Among those given the drug that fgure dropped to 12.5 per cent. Almost all the gains came from people with moderate to mild injury rather than severe injuries.

Haleema Shakur-Still, professor at the London School of Hygiene and Tropical Medicine, said that although the proportional improvement was small the numbers affected magnified the effects. “When you are dealing with a huge number of patients – 60 million each year – even a small percentage of that is significant,” she said.

Until now no medication has been shown to help with brain trauma. One of the most frustrating problems for doctors dealing with patients with head injuries is that sometimes they can watch them deteriorate rapidly after ostensibly moderate trauma as a result of continuing bleeding.

“You could lose a fair amount of blood if you fractured your leg, say, without it being really harmful” Professor Shakur-Still said, “In your head even a small bleed starts to put pressure on the brain. Our skull is a fixed box so it can’t expand to cope. It can lead to really bad outcomes.” “There is this thing that doctors describe… Patient will talk, then drop. They can be having a conversation then suddenly die. The bleeding is going on in their heads but because you can’t see it, you don’t realise.”

The research, published in the journal ‘The Lancet’, showed that it was possible to reduce the chances of this happening. Professor Shakur-Still said she hoped that it would spur research for even better treatments.
“There’s been many, many trials of all kinds of different drugs to look for improvements. To date, there has been nothing. This really offers hope because when you see drugs not delivering, investments tend to die.
“Showing Tranexamic Acid works will, with luck encourage the industry to look again, because there is hope.”

Peter McCabe, the chief executive of Headway, the brain injury association, welcomed the research. “Every three minutes someone is the UK is admitted to hospital with a head injury so it is encouraging to hear the findings of this study and the potential for TXA to help people. While this study does not demonstrate lives will be saved following severe brain injury, we know that the patients with mild to moderate brain injuries can suffer complications where TXA may be beneficial. It is also important to recognise that improvements in acute care have to be matched by investment in rehabilitation. Put simply, a life worth saving has to be a life worth living.”

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