This paper shows that tranexamic acid given up to 8 hours after primary intracerebral haemorrhage reduced haematoma expansion and early death compared with placebo without affecting rates of arterial and venous thrombosis or the number of seizures. However, the primary outcome at 90 days showed no difference in clinical function.

First thoughts are: tranexamic acid is “safe” to use in intracranial haemorrhage, which is good news for CRASH-3 and other trials. Secondly, although there was a reduction in haematoma expansion, it did not translate into better function. We at best would only expect a marginal effect, so maybe a larger trial is needed?

Beverley J.Hunt, FRCP, FRCPath, MD
Professor of Thrombosis and Haemostasis, King’s College London
Consultant, Guy’s and St Thomas’ NHS Foundation Trust
London, UK