Tranexamic acid to improve functional status in adults with spontaneous intracerebral haemorrhage: The TICH-2 RCT

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dc.authorid0000-0002-5871-8168
dc.contributor.authorSprigg, Nikola
dc.contributor.authorFlaherty, Katie
dc.contributor.authorAppleton, Jason P.
dc.contributor.authorAl-Shahi Salman, Rustam
dc.contributor.authorBereczki, Daniel
dc.contributor.authorBeridze, Maia
dc.contributor.authorCiccone, Alfonso
dc.contributor.authorCollins, Ronan
dc.contributor.authorDineen, Robert A.
dc.contributor.authorDuley, Lelia
dc.contributor.authorEgea-Guerrero, Juan José
dc.contributor.authorEngland, Timothy J.
dc.contributor.authorKarlinski, Michal
dc.contributor.authorKrishnan, Kailash
dc.contributor.authorLaska, Ann Charlotte
dc.contributor.authorLaw, Zhe Kang
dc.contributor.authorOvesen, Christian
dc.contributor.authorÖztürk, Şerefnur
dc.contributor.authorPocock, Stuart J.
dc.contributor.authorRoberts, Ian
dc.contributor.authorRobinson, Thompson G.
dc.contributor.authorRoffe, Christine
dc.contributor.authorPeters, Nils
dc.contributor.authorScutt, Polly
dc.contributor.authorThanabalan, Jegan
dc.contributor.authorWerring, David
dc.contributor.authorWhynes, David
dc.contributor.authorWoodhouse, Lisa
dc.contributor.authorBath, Philip M.
dc.date.accessioned2020-03-26T20:19:38Z
dc.date.available2020-03-26T20:19:38Z
dc.date.issued2019
dc.departmentSelçuk Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümüen_US
dc.description.abstractBackground: Tranexamic acid reduces death due to bleeding after trauma and postpartum haemorrhage. Objective: The aim of the study was to assess if tranexamic acid is safe, reduces haematoma expansion and improves outcomes in adults with spontaneous intracerebral haemorrhage (ICH). Design: The TICH-2 (Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage) study was a pragmatic, Phase III, prospective, double-blind, randomised placebo-controlled trial. Setting: Acute stroke services at 124 hospitals in 12 countries (Denmark, Georgia, Hungary, Ireland, Italy, Malaysia, Poland, Spain, Sweden, Switzerland, Turkey and the UK). Participants: Adult patients (aged >= 18 years) with ICH within 8 hours of onset. Exclusion criteria: Exclusion criteria were ICH secondary to anticoagulation, thrombolysis, trauma or a known underlying structural abnormality; patients for whom tranexamic acid was thought to be contraindicated; prestroke dependence (i.e. patients with a modified Rankin Scale [mRS] score > 4); life expectancy < 3 months; and a Glasgow Coma Scale score of < 5. Interventions: Participants, allocated by randomisation, received 1 g of an intravenous tranexamic acid bolus followed by an 8-hour 1-g infusion or matching placebo (i.e. 0.9% saline). Main outcome measure: The primary outcome was functional status (death or dependency) at day 90, which was measured by the shift in the mRS score, using ordinal logistic regression, with adjustment for stratification and minimisation criteria. Results: A total of 2325 participants (tranexamic acid, n = 1161; placebo, n = 1164) were recruited from 124 hospitals in 12 countries between 2013 and 2017. Treatment groups were well balanced at baseline. The primary outcome was determined for 2307 participants (tranexamic acid, n = 1152; placebo, n = 1155). There was no statistically significant difference between the treatment groups for the primary outcome of functional status at day 90 [adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.76 to 1.03; p = 0.11]. Although there were fewer deaths by day 7 in the tranexamic acid group (aOR 0.73, 95% CI 0.53 to 0.99; p = 0.041), there was no difference in case fatality at 90 days (adjusted hazard ratio 0.92, 95% CI 0.77 to 1.10; p = 0.37). Fewer patients experienced serious adverse events (SAEs) after treatment with tranexamic acid than with placebo by days 2 (p = 0.027), 7 (p = 0.020) and 90 (p = 0.039). There was no increase in thromboembolic events or seizures. Limitations: Despite attempts to enrol patients rapidly, the majority of participants were enrolled and treated > 4.5 hours after stroke onset. Pragmatic inclusion criteria led to a heterogeneous population of participants, some of whom had very large strokes. Although 12 countries enrolled participants, the majority (82.1%) were from the UK. Conclusions: Tranexamic acid did not affect a patient's functional status at 90 days after ICH, despite there being significant modest reductions in early death (by 7 days), haematoma expansion and SAEs, which is consistent with an antifibrinolytic effect. Tranexamic acid was safe, with no increase in thromboembolic events. Future work: Future work should focus on enrolling and treating patients early after stroke and identify which participants are most likely to benefit from haemostatic therapy. Large randomised trials are needed.en_US
dc.description.sponsorshipNational Institute for Health Research Health Technology Assessment programmeNational Institute for Health Research (NIHR); Pragmatic Trials, UK; Swiss Heart Foundation in Switzerlanden_US
dc.description.sponsorshipThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 35. See the NIHR Journals Library website for further project information. The project was also funded by the Pragmatic Trials, UK, funding call and the Swiss Heart Foundation in Switzerland.en_US
dc.identifier.citationSprigg, N., Flaherty, K., Appleton, J. P., Al-Shahi Salman, R., Bereczki, D., Beridze, M., Ciccone, A., Collins, R., Dineen, R. A., Duley, L., Egea-Guerrero, J. J., England, T. J., Karlinski, M., Krishnan, K., Laska, A C., Law, Z. K., Ovesen, C., Ozturk, S., Pocock, S. J., Roberts, I., Robinson, T. G., Roffe, C., Peters, N., Scutt, P., Thanabalan, J., Werring, D., Whynes, D., Woodhouse, L., Bath, P. M. (2019). Tranexamic Acid to Improve Functional Status in Adults with Spontaneous Intracerebral Haemorrhage: The TICH-2 RCT. Health Technology Assessment, 23(35).
dc.identifier.doi10.3310/hta23350en_US
dc.identifier.endpage+en_US
dc.identifier.issn1366-5278en_US
dc.identifier.issn2046-4924en_US
dc.identifier.issue35en_US
dc.identifier.pmid31322116en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1en_US
dc.identifier.urihttps://dx.doi.org/10.3310/hta23350
dc.identifier.urihttps://hdl.handle.net/20.500.12395/38349
dc.identifier.volume23en_US
dc.identifier.wosWOS:000475733300001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.institutionauthorOzturk, Serefnur.
dc.language.isoenen_US
dc.publisherNIHR JOURNALS LIBRARYen_US
dc.relation.ispartofHEALTH TECHNOLOGY ASSESSMENTen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.selcuk20240510_oaigen_US
dc.titleTranexamic acid to improve functional status in adults with spontaneous intracerebral haemorrhage: The TICH-2 RCTen_US
dc.typeArticleen_US

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