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Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
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Brilliant Board Review & CME
🎙️ Episode 38: TXA for ICH: Not the Magic Bullet
🧪 Study:
TXA within 2 hrs of ICH did not reduce hematoma expansion.
No benefit in functional outcome or mortality.
⚠️ Note:
Slight ↑ in thromboembolic events (3% vs 1%).
🧩 Clinical Takeaway:
No routine use for TXA in spontaneous ICH.
Still potential niche use in select trauma cases.
All right, let's talk about TXA for early intracranial hemorrhage Transanalamic acid. It's an antifibrillinic acid. It's used in trauma quite a lot and there's been no safe medical therapy for early treatment in intracerebral hemorrhage. Wouldn't that be wonderful, because it takes time for neurosurgeon to get there, or maybe we can stop it early, even not ever requiring neurosurgery, even consult. Wouldn't it be nice?
Speaker 1:This is a multinational clinical trial that was randomized. Patients with intracranial hemorrhage within two hours of the stroke received either TXA 1 gram over 10 minutes or 1 gram over 8, then 1 gram over 8 hours versus placebo or 1 gram over 8 hours versus placebo. They're excluded if a GCS is less than 8, I assume, because they're intubated and they're harder to follow, and a high rate of death and hematoma volume greater than 70 milliliters. So let's talk about the results 201 patients medium age 66. Good. 201 patients age medium age 66.
Speaker 1:And 84% had hemorrhages and a deep location in the brain. The median baseline hematoma was about 10 millimeters 10 milliliters. Hematoma growth was noted in 38% in the placebo group versus 43% in a TXA group. So, even though it was non-significant, the growth was actually bigger in a TXA group. And even though it was non-significant, the growth was actually bigger in a TXA group and the rate this is what you worry about with TXA is thromboembolic events was one percent in the placebo group, three percent in the TXA group. The 90-day mortality did not differ between the two groups, so unfortunately TXA is not a good medication. From this study for early intracranial hemorrhage.