Research
Print page Print page
Switch language
Bispebjerg Hospital - a part of Copenhagen University Hospital
Published

Tranexamic Acid for Prevention of Hematoma Expansion in Intracerebral Hemorrhage Patients With or Without Spot Sign

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Age At Menopause: A Female Risk Factor of Stroke?

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Cardiac Troponin I and Incident Stroke in European Cohorts: Insights From the BiomarCaRE Project

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Statistical analysis plan: Early mobilization by head-up tilt with stepping versus standard care after severe traumatic brain injury

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Interventions for altering blood pressure in people with acute subarachnoid haemorrhage

    Research output: Contribution to journalReviewResearchpeer-review

  4. Workforce Attachment after Ischemic Stroke – The Importance of Time to Thrombolytic Therapy

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

BACKGROUND AND PURPOSE: The computed tomography angiography or contrast-enhanced computed tomography based spot sign has been proposed as a biomarker for identifying on-going hematoma expansion in patients with acute intracerebral hemorrhage. We investigated, if spot-sign positive participants benefit more from tranexamic acid versus placebo as compared to spot-sign negative participants.

METHODS: TICH-2 trial (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) was a randomized, placebo-controlled clinical trial recruiting acutely hospitalized participants with intracerebral hemorrhage within 8 hours after symptom onset. Local investigators randomized participants to 2 grams of intravenous tranexamic acid or matching placebo (1:1). All participants underwent computed tomography scan on admission and on day 2 (24±12 hours) after randomization. In this sub group analysis, we included all participants from the main trial population with imaging allowing adjudication of spot sign status.

RESULTS: Of the 2325 TICH-2 participants, 254 (10.9%) had imaging allowing for spot-sign adjudication. Of these participants, 64 (25.2%) were spot-sign positive. Median (interquartile range) time from symptom onset to administration of the intervention was 225.0 (169.0 to 310.0) minutes. The adjusted percent difference in absolute day-2 hematoma volume between participants allocated to tranexamic versus placebo was 3.7% (95% CI, -12.8% to 23.4%) for spot-sign positive and 1.7% (95% CI, -8.4% to 12.8%) for spot-sign negative participants (Pheterogenity=0.85). No difference was observed in significant hematoma progression (dichotomous composite outcome) between participants allocated to tranexamic versus placebo among spot-sign positive (odds ratio, 0.85 [95% CI, 0.29 to 2.46]) and negative (odds ratio, 0.77 [95% CI, 0.41 to 1.45]) participants (Pheterogenity=0.88).

CONCLUSIONS: Data from the TICH-2 trial do not support that admission spot sign status modifies the treatment effect of tranexamic acid versus placebo in patients with acute intracerebral hemorrhage. The results might have been affected by low statistical power as well as treatment delay.

REGISTRATION: URL: http://www.controlled-trials.com; Unique identifier: ISRCTN93732214.

Original languageEnglish
JournalStroke
Volume52
Issue number8
Pages (from-to)2629-2636
Number of pages8
ISSN0039-2499
DOIs
Publication statusPublished - Aug 2021

    Research areas

  • angiography, cerebral hemorrhage, computed tomography angiography, hematoma, tranexamic acid, Humans, Middle Aged, Tranexamic Acid/therapeutic use, Cerebral Hemorrhage/diagnostic imaging, Male, Tomography, X-Ray Computed, Treatment Outcome, Computed Tomography Angiography, Disease Progression, Cerebral Angiography, Antifibrinolytic Agents/therapeutic use, Aged, 80 and over, Female, Aged, Hematoma/diagnostic imaging

ID: 66257122