.png)
Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
Stay sharp, stay current, and stay confident with Brilliant Medicine — the go-to podcast for Internal Medicine and Family Medicine physicians, residents, nurse practitioners, and physician assistants.
Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
🩺 Fast. Practical. Evidence-based.
This is the update your medical brain craves.
Brilliant Board Review & CME
🎙️ Episode 38: TXA for ICH: Not the Magic Bullet
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
🧪 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.
Introduction to TXA for Brain Hemorrhage
Speaker 1All 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 1This 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 1And
Clinical Trial Results Revealed
Speaker 184% 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
Conclusion: TXA's Ineffectiveness
Speaker 1.