| Title: |
Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: A secondary analysis of a large randomised controlled trial |
| Authors: |
Appleton, Jason Philip; Kang, Zhe; Woodhouse, Lisa Jane; Al-Shahi Salman, Rustam; Beridze, Maia; Christensen, Hanne; Dineen, Robert A.; Egea-Guerrero, Juan Jose; England, Timothy J.; Karlinski, Michal; Krishnan, Kailash; Laska, Ann Charlotte; Lyrer, Philippe A; Ozturk, Serefnur; Roffe, Christine; Roberts, Ian; Robinson, Thompson G; Scutt, Polly; Werring, David J; Bath, Philip M; Sprigg, Nikola |
| Publisher Information: |
BMJ Publishing Group |
| Publication Year: |
2023 |
| Collection: |
University of Nottingham: Repository@Nottingham |
| Subject Terms: |
Neurology (clinical); Neurology |
| Description: |
Background Tranexamic acid reduced haematoma expansion and early death, but did not improve functional outcome in the tranexamic acid for hyperacute spontaneous intracerebral haemorrhage-2 (TICH-2) trial. In a predefined subgroup, there was a statistically significant interaction between prerandomisation baseline systolic blood pressure (SBP) and the effect of tranexamic acid on functional outcome (p=0.019). Methods TICH-2 was an international prospective double-blind placebo-controlled randomised trial evaluating intravenous tranexamic acid in patients with acute spontaneous intracerebral haemorrhage (ICH). Prerandomisation baseline SBP was split into predefined ≤170 and >170 mm Hg groups. The primary outcome at day 90 was the modified Rankin Scale (mRS), a measure of dependency, analysed using ordinal logistic regression. Haematoma expansion was defined as an increase in haematoma volume of >33% or >6 mL from baseline to 24 hours. Data are OR or common OR (cOR) with 95% CIs, with significance at p170 mm Hg. Tranexamic acid was associated with a favourable shift in mRS at day 90 in those with baseline SBP≤170 mm Hg (cOR 0.73, 95% CI 0.59 to 0.91, p=0.005), but not in those with baseline SBP>170 mm Hg (cOR 1.05, 95% CI 0.85 to 1.30, p=0.63). In those with baseline SBP≤170 mm Hg, tranexamic acid reduced haematoma expansion (OR 0.62, 95% CI 0.47 to 0.82, p=0.001), but not in those with baseline SBP>170 mm Hg (OR 1.02, 95% CI 0.77 to 1.35, p=0.90). Conclusions Tranexamic acid was associated with improved clinical and radiological outcomes in ICH patients with baseline SBP≤170 mm Hg. Further research is needed to establish whether certain subgroups may benefit from tranexamic acid in acute ICH. Trial registration number ISRCTN93732214. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://nottingham-repository.worktribe.com/output/18998304; BMJ Neurology Open; Volume 5; Issue 1 |
| DOI: |
10.1136/bmjno-2023-000423 |
| Availability: |
https://doi.org/10.1136/bmjno-2023-000423; https://nottingham-repository.worktribe.com/file/18998304/1/Effects%20of%20blood%20pressure%20and%20tranexamic%20acid%20in%20spontaneous%20intracerebral%20haemorrhage%3A%20a%20secondary%20analysis%20of%20a%20large%20randomised%20controlled%20trial; https://nottingham-repository.worktribe.com/output/18998304 |
| Rights: |
openAccess ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.12045DA6 |
| Database: |
BASE |