Intravenous tranexamic acid for hyperacute primary intracerebral hemorrhage: Protocol for a randomized, placebo-controlled trial

on behalf of TICH-2 Investigators

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

Rationale: Outcome after intracerebral hemorrhage remains poor. Tranexamic acid is easy to administer, readily available, inexpensive, and effective in other hemorrhagic conditions. Aim: This randomized trial aims to test the hypothesis that intravenous tranexamic acid given within 8 h of spontaneous intracerebral hemorrhage reduces death or dependency. Design: Phase III prospective double-blind randomized placebo-controlled trial. Participants within 8 h of spontaneous intracerebral hemorrhage are randomized to receive either intravenous tranexamic acid 1 g 10 min bolus followed by 1 g 8 h infusion, or placebo. Sample size estimates: A trial of 2000 participants (300 from start-up phase and 1700 from main phase) will have 90% power to detect an ordinal shift of the modified Rankin Scale with odds ratio 0.79. Study outcomes: The primary outcome is death or dependency measured by ordinal shift analysis of the 7 level mRS at day 90. Secondary outcomes are neurological impairment at day 7 and disability, quality of life, cognition, and mood at day 90. Safety outcomes are death, serious adverse events, thromboembolic events, and seizures. Cost outcomes are length of stay in hospital, readmission, and institutionalization. Discussion: This pragmatic trial is assessing efficacy of tranexamic acid after spontaneous intracerebral hemorrhage. Recruitment started in 2013; as of 15th January 2016 1355 participants have been enrolled, from 95 centers in seven countries. Recruitment is due to end in 2017. TICH-2 Trial is registered as ISRCTN93732214.

Original languageEnglish
Pages (from-to)683-694
Number of pages12
JournalInternational Journal of Stroke
Volume11
Issue number6
DOIs
Publication statusPublished - 1 Aug 2016
Externally publishedYes

Fingerprint

Tranexamic Acid
Cerebral Hemorrhage
Randomized Controlled Trials
Placebos
Pragmatic Clinical Trials
Patient Readmission
Institutionalization
Sample Size
Cognition
Length of Stay
Seizures
Odds Ratio
Quality of Life
Outcome Assessment (Health Care)
Safety
Costs and Cost Analysis
Dependency (Psychology)

Keywords

  • Hyperacute intracerebral hemorrhage
  • placebo controlled
  • randomized trial
  • tranexamic acid

ASJC Scopus subject areas

  • Neurology

Cite this

Intravenous tranexamic acid for hyperacute primary intracerebral hemorrhage : Protocol for a randomized, placebo-controlled trial. / on behalf of TICH-2 Investigators.

In: International Journal of Stroke, Vol. 11, No. 6, 01.08.2016, p. 683-694.

Research output: Contribution to journalReview article

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abstract = "Rationale: Outcome after intracerebral hemorrhage remains poor. Tranexamic acid is easy to administer, readily available, inexpensive, and effective in other hemorrhagic conditions. Aim: This randomized trial aims to test the hypothesis that intravenous tranexamic acid given within 8 h of spontaneous intracerebral hemorrhage reduces death or dependency. Design: Phase III prospective double-blind randomized placebo-controlled trial. Participants within 8 h of spontaneous intracerebral hemorrhage are randomized to receive either intravenous tranexamic acid 1 g 10 min bolus followed by 1 g 8 h infusion, or placebo. Sample size estimates: A trial of 2000 participants (300 from start-up phase and 1700 from main phase) will have 90{\%} power to detect an ordinal shift of the modified Rankin Scale with odds ratio 0.79. Study outcomes: The primary outcome is death or dependency measured by ordinal shift analysis of the 7 level mRS at day 90. Secondary outcomes are neurological impairment at day 7 and disability, quality of life, cognition, and mood at day 90. Safety outcomes are death, serious adverse events, thromboembolic events, and seizures. Cost outcomes are length of stay in hospital, readmission, and institutionalization. Discussion: This pragmatic trial is assessing efficacy of tranexamic acid after spontaneous intracerebral hemorrhage. Recruitment started in 2013; as of 15th January 2016 1355 participants have been enrolled, from 95 centers in seven countries. Recruitment is due to end in 2017. TICH-2 Trial is registered as ISRCTN93732214.",
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