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Ultra-Early Tranexamic Acid After Subarachnoid Haemorrhage (ULTRA): A Randomised Controlled Trial

By Currents Editor posted 01-19-2021 13:43

  

The Lancet (01/09/21) Vol. 397, No. 10269, P. 112; doi: 10.1016/S0140-6736(20)32518-6

Post, René; Germans, Menno R.; Tjerkstra, Maud A.; et al.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32518-6/fulltext

 

The use of ultra-early, short-term tranexamic acid did not boost clinical outcomes at six months for patients with subarachnoid hemorrhage likely caused by a ruptured aneurysm, a new study shows. The prospective, randomized, controlled open-label trial enrolled 955 adult patients with spontaneous computed tomography (CT)-proven subarachnoid hemorrhage in the Netherlands. Patients were randomly assigned to tranexamic acid plus usual care, with treatment started immediately after diagnosis in the presenting hospital, or to usual care only. Tranexamic acid treatment consisted of a 1 g bolus, followed by continuous infusion of 1 g every eight hours, stopped immediately before aneurysm treatment, or 24 hours after start of the medication, whichever came first. The intention-to-treat analysis found a good clinical outcome — a score of 0-3 on the modified Rankin Scale at six months — in 60% (287) of 475 patients in the tranexamic acid group and 64% (300) of 470 patients in the control group. Rebleeding after randomization and prior to aneurysm treatment occurred in 10% (49) of the tranexamic group and 14% (66) of the control group. With no differences in serious adverse events or baselines differences in the two groups, the researchers suggest that other factors, such as early brain injury or not-predefined complications, may contribute to the poor outcome.

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