From the Guidelines
Tranexamic Acid (TXA) in Spontaneous Intracranial Hemorrhage
TXA does not significantly improve outcomes for spontaneous intracranial hemorrhage.
- The current evidence suggests that while TXA may reduce the progression of intracranial hemorrhage, its effect on mortality and disability is unclear 1.
- A small RCT of tranexamic acid in ICH demonstrated neither benefit nor safety concerns, indicating a need for further research 1.
- The European Society of Intensive Care Medicine recommends the use of TXA in patients with mild to moderate traumatic brain injury, but its use in spontaneous intracranial hemorrhage is still conditional due to lack of certainty around patient-important effects 1.
- Ongoing trials, such as the Stopping Haemorrhage With Tranexamic Acid for Hyperacute Onset Presentation Including Mobile Stroke Units Trial, aim to evaluate the effectiveness of TXA in the hyperacute time frame of ICH 1.
- Further research is required to determine the role of TXA in spontaneous intracranial hemorrhage, including its potential benefits and risks in different patient populations 1.
- Key factors to consider in future studies include the timing of TXA administration, patient selection, and the use of standardized outcome measures to assess the effectiveness of TXA in improving patient outcomes 1.
From the Research
Tranexamic Acid and Spontaneous Intracranial Hemorrhage
- Tranexamic acid (TXA) has been studied for its potential to improve outcomes in patients with spontaneous intracranial hemorrhage (ICH) 2, 3, 4, 5.
- The evidence suggests that TXA may reduce the risk of hematoma expansion in patients with ICH, particularly when treated within 4.5 hours of symptom onset 3, 5.
- However, the effect of TXA on functional outcomes and mortality in patients with ICH is less clear, with some studies suggesting no significant difference between TXA and placebo 2, 3, 5.
Efficacy and Safety of Tranexamic Acid
- TXA has been shown to be safe for use in patients with ICH, without increasing the risk of thromboembolic complications 3, 4, 5.
- The meta-analysis by 4 found that TXA significantly inhibited hematoma growth in ICH patients, and reduced the risk of hydrocephalus and rebleeding in patients with subarachnoid hemorrhage.
- However, the study by 2 noted that TXA did not result in a difference in functional status, and that more data are needed to determine which patient subpopulations are most likely to benefit from TXA.
Clinical Implications
- The use of TXA in patients with spontaneous ICH may be considered as a potential treatment to reduce hematoma expansion, particularly in patients treated within 4.5 hours of symptom onset 3, 5.
- However, the decision to use TXA should be made on a case-by-case basis, taking into account the individual patient's risk factors and clinical presentation 6.
- Further studies are needed to fully understand the efficacy and safety of TXA in patients with ICH, and to determine the optimal dosing and timing of administration 2, 3, 4, 5, 6.