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The Effect of Tranexamic Acid on Neurosurgical Intervention in Spontaneous Intracerebral Hematoma: Data From 121 Surgically Treated Participants From the Tranexamic Acid in IntraCerebral Hemorrhage-2 Randomized Controlled Trial

Hollingworth, Milo; Woodhouse, Lisa J.; Law, Zhe K.; Ali, Azlinawati; Krishnan, Kailash; Dineen, Robert A.; Christensen, Hanne; England, Timothy J.; Roffe, Christine; Werring, David; Peters, Nils; Ciccone, Alfonso; Robinson, Thompson; Członkowska, Anna; Bereczki, Dániel; Egea-Guerrero, Juan José; Ozturk, Serefnur; Bath, Philip M.; Sprigg, Nikola

The Effect of Tranexamic Acid on Neurosurgical Intervention in Spontaneous Intracerebral Hematoma: Data From 121 Surgically Treated Participants From the Tranexamic Acid in IntraCerebral Hemorrhage-2 Randomized Controlled Trial Thumbnail


Authors

Milo Hollingworth

Zhe K. Law

Azlinawati Ali

Kailash Krishnan

Hanne Christensen

Christine Roffe

David Werring

Nils Peters

Alfonso Ciccone

Thompson Robinson

Anna Członkowska

Dániel Bereczki

Juan José Egea-Guerrero

Serefnur Ozturk



Abstract

BACKGROUND AND OBJECTIVES:
An important proportion of patients with spontaneous intracerebral hemorrhage (ICH) undergo neurosurgical intervention to reduce mass effect from large hematomas and control the complications of bleeding, including hematoma expansion and hydrocephalus. The Tranexamic acid (TXA) for hyperacute primary IntraCerebral Hemorrhage (TICH-2) trial demonstrated that tranexamic acid (TXA) reduces the risk of hematoma expansion. We hypothesized that TXA would reduce the frequency of surgery (primary outcome) and improve functional outcome at 90 days in surgically treated patients in the TICH-2 data set.

METHODS:
Participants enrolled in TICH-2 were randomized to placebo or TXA. Participants randomized to either TXA or placebo were analyzed for whether they received neurosurgery within 7 days and their characteristics, outcomes, hematoma volumes (HVs) were compared. Characteristics and outcomes of participants who received surgery were also compared with those who did not.

RESULTS:
Neurosurgery was performed in 5.2% of participants (121/2325), including craniotomy (57%), hematoma drainage (33%), and external ventricular drainage (21%). The number of patients receiving surgery who received TXA vs placebo were similar at 4.9% (57/1153) and 5.5% (64/1163), respectively (odds ratio [OR] 0.893; 95% CI 0.619-1.289; P-value = .545). TXA did not improve outcome compared with placebo in either surgically treated participants (OR 0.79; 95% CI 0.30-2.09; P = .64) or those undergoing hematoma evacuation by drainage or craniotomy (OR 1.19 95% 0.51-2.78; P-value = .69). Postoperative HV was not reduced by TXA (mean difference −8.97 95% CI −23.77, 5.82; P-value = .45).

CONCLUSION:
TXA was not associated with less neurosurgical intervention, reduced HV, or improved outcomes after surgery.

Citation

Hollingworth, M., Woodhouse, L. J., Law, Z. K., Ali, A., Krishnan, K., Dineen, R. A., Christensen, H., England, T. J., Roffe, C., Werring, D., Peters, N., Ciccone, A., Robinson, T., Członkowska, A., Bereczki, D., Egea-Guerrero, J. J., Ozturk, S., Bath, P. M., & Sprigg, N. (2024). The Effect of Tranexamic Acid on Neurosurgical Intervention in Spontaneous Intracerebral Hematoma: Data From 121 Surgically Treated Participants From the Tranexamic Acid in IntraCerebral Hemorrhage-2 Randomized Controlled Trial. Neurosurgery, 95(3), 605-616. https://doi.org/10.1227/neu.0000000000002961

Journal Article Type Article
Acceptance Date Jan 28, 2024
Online Publication Date May 24, 2024
Publication Date Sep 1, 2024
Deposit Date Jun 17, 2024
Publicly Available Date Jun 18, 2024
Journal Neurosurgery
Print ISSN 0148-396X
Electronic ISSN 1524-4040
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 95
Issue 3
Pages 605-616
DOI https://doi.org/10.1227/neu.0000000000002961
Keywords Tranexamic acid; Intracerebral hemorrhage; Neurosurgery; Stroke
Public URL https://nottingham-repository.worktribe.com/output/35160145
Publisher URL https://journals.lww.com/neurosurgery/fulltext/9900/the_effect_of_tranexamic_acid_on_neurosurgical.1177.aspx

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