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
Dr. Renee Bradley is an Emergency Medicine and chief resident at the University of Ottawa.
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
Dr. Perry is an Emergency Physician and full Professor in the department of Epidemiology and Community Medicine. He has a special research interest in subarachnoid hemorrhage, TIA and stroke.