Abstract Details

A recent subgroup analysis of the CRASH-3 trial demonstrated a mortality benefit of TXA in post TBI patients with non-moribund injuries when TXA was administered within 3 hours.  A more recent study showed a trend towards decreased mortality with a 2 gram TXA bolus within 2 hours of injury.  Neither study reported data analysis on employability post TBI.

Determine if early administration of TXA post TBI in non-moribund military age patients increases the odds of return to full employability.

Data was collected from the CRASH-3 dataset (12,658 patients were enrolled and eligible for the trial).  Moribund and patients age <18 and > 49 were removed to age match the US Military population; 6661 patients qualified.  Regression analysis was used to control for sex, age, GCS, pupillary reactivity (unilateral vs. bilateral), systolic blood pressure (SBP), and major intracranial hemorrhage at time of admission. Primary outcomes of ‘days in the ICU’ and ‘full employability’ in 2 study groups were assessed: 1. TXA administered within 3 hours of injury and 2. TXA administered within 1 hour of injury.

TBI patients who received TXA within 3 hours of injury were 83% male, mean age 30, mean SBP 123mmHg, mean GCS 10, and 50.7% received TXA.  Similarly; the subgroup that received TXA within 1 hour of injury were 83% male, mean age 29, mean SBP 123mmHg, mean GCS 10, and 53.7% received TXA.  Only the subgroup that received TXA within 1 hour of injury showed statistical significant decrease in ICU days (0.8 less day; p-value 0.04) and full employability (odds ratio 1.66; p-value 0.006) with TXA administration.

This post-hoc analysis suggests that TXA administration within 1 hour of TBI in non-moribund military age patients could increase the odds of return to full employability; and possibly help sustain combat power for the Military.