Takeaway
- Tranexamic acid treatment reduced rebleeding and haematoma expansion in patients with cerebral haemorrhage without increasing single ischaemic adverse events.
- Tranexamic acid does not improve mortality or functional outcomes.
- Risk for combined ischaemic events increased with tranexamic acid.
Why this matters
- Risk-to-benefit ratio should be assessed before using tranexamic acid for the treatment of cerebral haemorrhage.
Study design
- Meta-analysis of 14 randomised controlled trials including 4703 participants who received either tranexamic acid or placebo.
- Funding: China Scholarship Council.
Key results
- Tranexamic acid did not improve 90-day mortality (OR, 0.99; P=.95) or 180-day mortality (OR, 1.01; P=.98) vs placebo.
- Patients with poor functional outcomes were similar between groups (OR, 0.95; P=.55).
- Tranexamic acid was associated with lower incidence of haematoma expansion (OR, 0.54; P=.002).
- Subanalysis shows significant difference in patients with subarachnoid haemorrhage (OR, 0.48; P=.003), but not in patients with spontaneous intracerebral haemorrhage (OR, 0.75; P=.53).
- Change in haemorrhage volume was significantly less with tranexamic acid (mean difference (MD), −1.98; P=.0001).
- Subanalysis shows significant difference for patients with smaller change in haemorrhage volume (MD, −3.29; P=.0001), but not in those with a larger change in haemorrhage volume (MD, −1.22; P=.06).
- The risk for hydrocephalus (OR, 1.21; P=.21), ischaemic stroke (OR, 1.43; P=.16), deep vein thrombosis (OR, 1.25; P=.40) and pulmonary embolism (OR, 0.97; P=.89) was similar between groups.
- The risk for combined ischaemic events increased in the tranexamic acid group (OR, 1.47; P=.02).
Limitations
- Heterogeneity across studies.
References
References
