This seemingly humble drug may help stop the bleeding in case of traumatic brain injury

Tranexamic acid, a drug you might have been given after a bloody tooth extraction, may now be used in the treatment of brain injuries. Earlier this week,  The Lancet  — a peer-reviewed journal — published research that shows that Tranexamic acid helps to form blood clots after a traumatic brain injury. The research was conducted over seven years. [caption id=“attachment_7514241” align=“alignleft” width=“380”]  Representational image. Image source: Getty Images.[/caption] This finding could be important for us in India for at least two reasons. One, at around Rs 41 an injection, the drug is inexpensive and already widely available in the market. Two, traumatic brain injury is more common than we realise. Globally, around 69 million people get a traumatic brain injury each year. Traumatic brain injuries are a leading cause of illness, death, disability and socioeconomic losses in India - road accidents contribute 60% of traumatic brain injuries in the country, followed by falling (20-25%) and violence (10%).

How does the drug work

One of the most common complications of traumatic brain injuries is bleeding inside the brain (intracranial bleeding) which increases the risk of death and disability. On 14 October,  The Lancet  published the findings of a seven-year international, multi-centre trial done with more than 12,000 patients - each of whom had a traumatic brain injury. The CRASH-3 (Clinical Randomisation of an Antifibrinolytic in Significant Head Injury) trial showed that in patients with major extracranial bleeding (bleeding outside the skull), giving a Tranexamic acid tablet within 3 hours of head injury (early administration) may reduce the instances of death by bleeding by a third.

Multiple uses of Tranexamic acid

Developed by Japanese researchers in the 1960s, Tranexamic acid is on the World Health Organization’s list of essential medicines. It has multiple uses, such as:

• Short-term use for patients with haemophilia, to reduce or prevent haemorrhage.
• To stop heavy bleeding following a tooth extraction.
• For people with cyclic menorrhagia (excessive bleeding during menstruation).
• For the treatment of epistaxis (nosebleeds) in patients with hereditary hemorrhagic telangiectasia.
• For angioedema (allergic reactions to a food item or drug) in patients with hereditary angioedema.
• For orthopaedic surgical bleeding present in primary total hip or knee arthroplasty (like knee replacement and hip replacement surgeries).

How does it work in brain injury?

Tranexamic acid tablets have been shown to save lives in the case of brain injury. Tranexamic acid works against the enzymes (plasmin) which destroy blood clots - clotting is essential to stop the bleeding. Tranexamic acid should be given within the first three hours of injury - even a short delay in treatment reduces the efficacy of the drug.

What are the available forms of Tranexamic acid?

It is available in the form of:

• Topical cream
• Tablet
• Injectable solution

When is it not advised

As with any drug, Tranexamic acid has its do’s and don’ts. For example, researchers found that while Transexamic acid tablet can provide relief after a brain injury, a Transexamic acid injection does not produce the same results. Transexamic acid is not used for:

• People diagnosed with leukaemia.
• People living with thromboembolic diseases like cerebral thrombosis and pulmonary thrombosis who take blood thinners to avoid the formation of a blood clot.
• Pregnant women: Tranexamic acid can cross the placenta and appear in cord blood - meaning, it can reach the baby.
• In people who already have visual disturbances like retinal artery and retinal vein occlusions (closing). Some patients also experience these visual disturbances as a side-effect of Tranexamic acid - in their case also, the drug is discontinued.
• In women who are breastfeeding: About one-hundredth of the dose that a new mom gets could enter the breastmilk
• In people with kidney failure, doctors may adjust the dosage. This is because Tranexamic acid is eventually flushed out of the body through urine.

Head injury first-aid

There is very little that a bystander can, and should, do apart from calling an ambulance and covering the injury site with a clean cloth. Without taking any extreme measures until medical help arrives, here’s what you can do:

• Assess if the person is conscious. Check if they are breathing.
• If they’re not breathing, gently check for any obstruction in the airway. If need be, use your fingers to gently remove anything that might be obstructing the patient’s breath.
• If the patient is conscious, comfort them. Take care not destabilize their neck under any circumstances.
• Call for an ambulance or medical help.
• Keep checking for breath every few minutes by placing two fingers of your hand underneath their nostrils.
• Until medical help arrives, cover the wound with a sterile or clean cloth to stop the bleeding. Do not put too much pressure on the wound.
• Check for any other injury on the body and give first-aid for that.
• Maintain the patient’s body temperature - simply putting a blanket or sheet to cover them can help.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, read our article on   Brain Injury: Symptoms, Causes, Treatment, Medicines_._