Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials

Zhe Kang Law, Atte Meretoja, Stefan T. Engelter, Hanne Christensen, Eugenia Maria Muresan, Solveig B. Glad, Liping Liu, Philip M. Bath, Nikola Sprigg

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH. Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further details. Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid. Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established. Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

Original languageEnglish
Pages (from-to)13-22
Number of pages10
JournalEuropean Stroke Journal
Volume2
Issue number1
DOIs
Publication statusPublished - 1 Mar 2017

Fingerprint

Tranexamic Acid
Cerebral Hemorrhage
Hematoma
Hemostatics
Clinical Trials
Therapeutics
Randomized Controlled Trials
Hemorrhage
Antifibrinolytic Agents
Glasgow Coma Scale
Reducing Agents
MEDLINE
Patient Selection
Uncertainty
Observational Studies
Publications
Placebos

Keywords

  • anti-fibrinolytic
  • clinical trials
  • haematoma expansion
  • haemostatic agent
  • intracerebral haemorrhage
  • spot sign
  • systematic reviews
  • Tranexamic acid

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials. / Law, Zhe Kang; Meretoja, Atte; Engelter, Stefan T.; Christensen, Hanne; Muresan, Eugenia Maria; Glad, Solveig B.; Liu, Liping; Bath, Philip M.; Sprigg, Nikola.

In: European Stroke Journal, Vol. 2, No. 1, 01.03.2017, p. 13-22.

Research output: Contribution to journalReview article

Law, ZK, Meretoja, A, Engelter, ST, Christensen, H, Muresan, EM, Glad, SB, Liu, L, Bath, PM & Sprigg, N 2017, 'Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials', European Stroke Journal, vol. 2, no. 1, pp. 13-22. https://doi.org/10.1177/2396987316676610
Law, Zhe Kang ; Meretoja, Atte ; Engelter, Stefan T. ; Christensen, Hanne ; Muresan, Eugenia Maria ; Glad, Solveig B. ; Liu, Liping ; Bath, Philip M. ; Sprigg, Nikola. / Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials. In: European Stroke Journal. 2017 ; Vol. 2, No. 1. pp. 13-22.
@article{c965fd1a5ddd46bea8e667fd08f7d81e,
title = "Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials",
abstract = "Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH. Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further details. Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid. Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established. Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.",
keywords = "anti-fibrinolytic, clinical trials, haematoma expansion, haemostatic agent, intracerebral haemorrhage, spot sign, systematic reviews, Tranexamic acid",
author = "Law, {Zhe Kang} and Atte Meretoja and Engelter, {Stefan T.} and Hanne Christensen and Muresan, {Eugenia Maria} and Glad, {Solveig B.} and Liping Liu and Bath, {Philip M.} and Nikola Sprigg",
year = "2017",
month = "3",
day = "1",
doi = "10.1177/2396987316676610",
language = "English",
volume = "2",
pages = "13--22",
journal = "European Stroke Journal",
issn = "2396-9873",
publisher = "Sage Publications",
number = "1",

}

TY - JOUR

T1 - Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials

AU - Law, Zhe Kang

AU - Meretoja, Atte

AU - Engelter, Stefan T.

AU - Christensen, Hanne

AU - Muresan, Eugenia Maria

AU - Glad, Solveig B.

AU - Liu, Liping

AU - Bath, Philip M.

AU - Sprigg, Nikola

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH. Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further details. Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid. Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established. Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

AB - Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH. Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further details. Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid. Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established. Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

KW - anti-fibrinolytic

KW - clinical trials

KW - haematoma expansion

KW - haemostatic agent

KW - intracerebral haemorrhage

KW - spot sign

KW - systematic reviews

KW - Tranexamic acid

UR - http://www.scopus.com/inward/record.url?scp=85047393913&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047393913&partnerID=8YFLogxK

U2 - 10.1177/2396987316676610

DO - 10.1177/2396987316676610

M3 - Review article

AN - SCOPUS:85047393913

VL - 2

SP - 13

EP - 22

JO - European Stroke Journal

JF - European Stroke Journal

SN - 2396-9873

IS - 1

ER -