Post R, et al. Lancet. 2021 Jan 9;397(10269):112-118. doi: 10.1016/S0140-6736(20)32518-6.
Question and Methods: This prospective, multicentre, randomized, controlled, open-label trial investigated whether administering TXA ultra-early in presumed aneurysmal SAH improves clinical outcomes at 6 months.
Findings: In patients with spontaneous presumed aneurysmal SAH, ultra-early TXA treatment initiated immediately after diagnosis resulted in good clinical outcomes (modified Rankin Scale 0-3) at 6 months in 60% of patients in the TXA group and 64% in control group (OR 0.86, 95%CI 0.66-1.12).
Limitations: This was an open-label study, thus introducing treatment bias, and the inclusion of patients without underlying aneurysm on CTA may have diluted the treatment effects of TXA.
Interpretation: Based on the results from this trial, ultra-early administration of TXA (with maximum treatment duration of 24h) does not improve clinical outcomes at 6 months and should not be routinely administered.
JC Supervisor: Dr. Jeff Perry