CRASH-3 deserves unending respect. It is, simply put, the most impressive study in the history of head injury, pitting tranexamic acid against placebo in more than ten thousand subjects. Yeah. Ten thousand. In fact, for blunt trauma (CRASH2, 2010) and postpartum hemorrhage (WOMAN, 2017) the same research group enrolled twenty thousand subjects—in each trial. CRASH-3 is therefore the third mega-trial from this record-setting consortium.
Unfortunately, CRASH-3 found zero benefit, and it wasn’t close. This is despite an awkward, denominator-shifting, bizarro-world paper that aggressively claims benefit. The authors seem to earnestly believe in the drug, and again they are research superstars. But even a cursory glance shows tranexamic acid didn’t work. Either that, or the trial was too small (seriously), in which case the drug effect is microscopic.