Methodology: 4.5/5
Usefulness: 4/5

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.

By: Dr. Renee Bradley

JC Supervisor: Dr. Jeff Perry

 

 

Authors

  • 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, assistant 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.