Tranexamic Acid for hyperacute primary IntraCerebral Haemorrhage

Sprigg, N et al. The Lancet 2018; doi: 10.1016/S0140-6736(18)31033-X

Clinical Question

• In adults with acute, spontaneous intra-cerebral haemorrhage (ICH) does the administration of tranexamic acid (TXA) compared to a placebo improve functional status at 90 days?

N = 2325, 124 hospitals in 12 countries

Authors’ Conclusions

-  TXA does not affect functional status at day 90, although some potential benefits were noted with regards to reduction in haematoma expansion, early death and numbers of serious adverse events

The Bottom Line

• The signal of benefit from tranexamic acid administration seen in this trial has not been proven by conventional statistical significance thresholds
• Given some non-significant trends in certain subgroups and low rates of serious events, further work looking at certain subgroups should be considered to identify patients that may benefit
• The complementary CRASH-3 trial, investigating tranexamic acid administration in traumatic head injuries, will expand the evidence base in this area when published
• Given the good safety profile and potential small benefit, it is reasonable to administer tranexamic acid early in patients with intracerebral haemorrhage