Tranexamic acid does little to prevent hematoma expansion in patients with NOAC-ICH

There is no evidence to suggest that treatment with tranexamic acid (TXA) helps limit hematoma expansion in patients with intracerebral haemorrhage (ICH) associated with nonvitamin K antagonist oral anticoagulants (NOACs), according to a study.

In the study, 63 patients (median age 82 years, 40 percent women; median hematoma volume 11.5 mL) with NOAC-ICH were randomly assigned to receive either intravenous TXA (1 g over 10 minutes, followed by 1 g over 8 hours; n=32) or matching placebo (n=31). All patients were given standard medical care. The study was discontinued prematurely due to exhausted funding.

The primary outcome of hematoma expansion, defined as ≥33-percent relative or ≥6-mL absolute volume increase at 24 hours, occurred with comparable frequency in the TXA and placebo arms (38 percent vs 45 percent; adjusted odds ratio [aOR], 0.63, 95 percent CI, 0.22–1.82; p=0.40).

Of note, a signal for interaction with onset-to-treatment time emerged (p=0.024 for interaction), with the results favouring TXA when administered within 6 hours of symptom onset.

Finally, the TXA and placebo arms did not differ in terms of the proportion of participants who died (47 percent vs 42 percent; aOR, 1.07, 95 percent CI, 0.37–3.04; p=0.91) or had major thromboembolic complications within 90 days (13 percent vs 6 percent; aOR, 1.86, 0.37–9.50; p=0.45).

All thromboembolic events occurred at least 2 weeks following study treatment, exclusively in participants who were not restarted on oral anticoagulation.

More studies on hemostatic treatments targeting an early treatment window are warranted for NOAC-ICH.