Tranexamic acid does not improve 90-day functional outcomes in patients with spontaneous intracerebral haemorrhage (ICH), but may reduce mortality and haematoma expansion when administered early, researchers report.

The analysis, the first of its kind in spontaneous ICH, assessed data from nine RCTs involving 3,194 patients.

It found that, at 90 days, a similar number of patients in the tranexamic acid (53.2%) and placebo (53.6%) groups had a worse functional outcome post ICH.

However, the treatment was linked with a reduction in early mortality at day seven (adjusted OR 0.70) and a lower risk of haematoma expansion (OR 0.81).

The findings were “consistent across clinical and radiological subgroups and robust in sensitivity analyses”, according to the paper, published in the Journal of Neurology, Neurosurgery & Psychiatry [link here].

While the findings do not support routine use of tranexamic acid in this setting, the early survival and haemostatic signals suggest a potential role for early administration or incorporation into future treatment strategies, according to the authors, who included consultant neurologist Dr Zhe Kang Law, University of Nottingham.

“Even a small treatment may have public health significance, especially in the context of an effective care bundle, given the global burden of ICH,” they said.

Larger ongoing trials, including TICH-3 and INTRINSIC, may help to clarify tranexamic acid’s role in early mortality, particularly in patients treated in less than 4.5 hours from symptom onset and those taking anticoagulants, they added.