Jason Philip Appleton
Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: A secondary analysis of a large randomised controlled trial
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
Authors
Zhe Kang
Dr LISA WOODHOUSE L.Woodhouse@nottingham.ac.uk
Research Fellow
Rustam Al-Shahi Salman
Maia Beridze
Hanne Christensen
ROBERT DINEEN rob.dineen@nottingham.ac.uk
Professor of Neuroradiology
Juan Jose Egea-Guerrero
TIMOTHY ENGLAND Timothy.England@nottingham.ac.uk
Professor of Stroke Medicine
Michal Karlinski
Kailash Krishnan
Ann Charlotte Laska
Philippe A Lyrer
Serefnur Ozturk
Christine Roffe
Ian Roberts
Thompson G Robinson
Polly Scutt
David J Werring
PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine
NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine
Abstract
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 p<0.05. Results Of 2325 participants in TICH-2, 1152 had baseline SBP≤170 mm Hg and were older, had larger lobar haematomas and were randomised later than 1173 with baseline SBP>170 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.
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 6, 2023 |
Online Publication Date | Jun 12, 2023 |
Publication Date | Jun 12, 2023 |
Deposit Date | Mar 28, 2023 |
Publicly Available Date | Mar 28, 2023 |
Journal | BMJ Neurology Open |
Electronic ISSN | 2632-6140 |
Publisher | BMJ |
Peer Reviewed | Peer Reviewed |
Volume | 5 |
Issue | 1 |
Article Number | e000423 |
DOI | https://doi.org/10.1136/bmjno-2023-000423 |
Keywords | Neurology (clinical); Neurology |
Public URL | https://nottingham-repository.worktribe.com/output/18998304 |
Publisher URL | https://neurologyopen.bmj.com/content/5/1/e000423 |
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Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: a secondary analysis of a large randomised controlled trial
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