Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial

RCT (n=2.325) found no difference in functional status at day 90 (primary outcome) for tranexamic acid vs placebo (adjusted OR 0.88, 95% CI 0.76 to 1.03), although there were fewer deaths by day 7 with tranexamic acid (9% vs 11% 0.73, 0.53 to 0.99).

Authors state that larger randomised trials are needed to confirm or refute a clinically significant treatment effect.

 

A related editorial discusses this research.  Additional subgroup analyses of haemorrhage growth at 3 h and 2 h after onset in the study database could clarify whether tranexamic acid’s limited effect on intracerebral haemorrhage growth is related to the strength of its haemostatic effect or the timing of treatment.  Whether the pathophysiology of intracerebral haemorrhage can be altered enough to improve clinical outcome remains one of the major questions in the treatment of acute stroke.  Further research is required