Randomized, Double-blind, Placebo-controlled Trial to Investigate the Effectiveness of Early Intravenous Tranexamic Acid in Limiting Hematoma Expansion in Patients With Spontaneous Intracerebral Hemorrhage
试验速览
- 阶段
- 3 期
- 入组人数
- 220
- 试验地点
- 1
- 主要终点
- Intracerebral hematoma volume (by computed tomography brain scan) at 6 hours
研究概览
简要总结
This study aims to explore the effectiveness of tranexamic acid (also known as trans amine or TXA) in reducing hematoma expansion in patients with hemorrhagic stroke when given in the acute phase.
METHODOLOGY
This will be a Phase III, parallel-group double-blind randomised placebo control trial. Patients allocated to the control group will receive standard care for hemorrhagic stroke according to the 2015 American Heart Association guidelines. Patients allocated to the intervention group will receive, in addition to standard care, a loading dose of intravenous TXA 1gm within 3 hours of symptom onset followed by a 1gm maintenance dose over 8 hours. Timing and dosing are in accordance to previous established study protocols. Patients in the intervention group will only receive a single treatment course of TXA.
Study subjects will be identified by either the on-duty clinicians from the Department of Neurosurgery of this institution or by the study investigators. Should the patient meet study eligibility criteria consent will be obtained either from the patient or from his/her next of kin. 1:1 block randomization will be performed by a remote internet randomization service by accessing a website. Patients allocated to the intervention arm will have 1gm of TXA added to 100ml of normal saline (0.9%) infused over 10 minutes as a loading dose. This is then followed by a maintenance dose of 1gm of TXA in 500ml of intravenous isotonic solution infused at 120mg/hour (60ml/hour) for 8 hours. Patient's allocated to the control arm will have an equal volume of normal saline (0.9%) infused as a placebo. The patient and the outcome assessor will be blinded to study group allocation.
The primary endpoint of this study will be to assess the percentage change in brain blood clot volume by computed tomography brain scans on admission, 6 hours later, at 24 hours and at 1 week.
详细描述
INTRODUCTION
There are very few treatment options for patients with spontaneous intracerebral hemorrhage, a type of hemorrhagic stroke especially prevalent among Chinese, during the acute phase. Blood clot expansion in the brain (hematoma expansion; HE) is one of the most significant predictors for poor outcome in such patients.
Tranexamic acid (TXA) is a commonly used medication available in all acute Hospital Authority hospitals prescribed for a variety of conditions when bleeding occurs, for example epistaxis and menorrhagia. Intravenous administration of TXA has been proven to benefit severe trauma patients by reducing mortality and also preventing the recurrent rupture of brain aneurysms in another type of hemorrhagic stroke. The medication is safe and has been proven to improve outcomes in these patients.
A previously performed pilot study exploring the safety and feasibility of administrating intravenous TXA to patients with hemorrhagic stroke was recently performed and concluded the medication's safety. There was also a trend to significance for reducing the percentage change of hematoma volume in patients who received TXA.
This study aims to explore the effectiveness of TXA in reducing hematoma expansion in patients with hemorrhagic stroke when given in the acute phase.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
盲法说明
Intravenous normal saline or transamine will be administered to subjects. Both will be of equal volume, colour and in similar intravenous fluid packaging.
The outcomes assessor will be unaware of the subject group allocation.
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with CT evidence of supratentorial intracerebral hemorrhage
- •Initiation of trial medication within 3 hours from the time of symptoms onset.
- •Ethnic Chinese
- •Reasonable expectation of completion of outcome measures at follow-up
- •Written informed consent from either the patient or next-of-kin or legal guardian.
排除标准
- •Patients not expected to survive 24 hours after admission.
- •Patients with brainstem herniation syndrome on admission.
- •Patients who need immediate neurosurgical intervention.
- •GCS of of 5 or less on admission i.e. a GCS score of 2 according to the Hemphil ICH score
- •Previous antiplatelet and anticoagulant medication use.
- •Known thrombocytopenia or coagulopathy.
- •Disseminated intravascular coagulation on admission.
- •Acute sepsis on admission.
- •Intracerebral hemorrhage (ICH) secondary to intracranial vascular lesion: aneurysm, arteriovenous malformation, neoplasm or dural venous sinus thrombosis.
- •Previous venous thromboembolic disease : deep venous thrombosis.
- •History of ischemic stroke or transient ischemic attack within 12 months.
- •History of ischemic heart disease or myocardial infarction.
- •History of peripheral vascular disease.
- •Patients with previous disability (prestroke modified Rankin scale score >2)
- •Pregnancy or breast feeding.
- •History of allergy to tranexamic acid
研究组 & 干预措施
Intervention
Standard management for patients with spontaneous intracerebral hemorrhage according to 2015 AHA/ASA Guidelines for the Management of Intracerebral Hemorrhage
AND
Patients will have 1gram of tranexamic acid (diluted in 100ml of normal saline 0.9%) intravenously infused over 10 minutes within 3 hours of symptom presentation and another 1 gram of tranexamic acid (diluted in 100ml of normal saline 0.9%) infused over 8 hours.
干预措施: Tranexamic Acid (Drug)
结局指标
主要结局
Intracerebral hematoma volume (by computed tomography brain scan) at 6 hours
时间窗: At 6 hours
Intracerebral hematoma volume (ml) as assessed by CT brain scan.
Intracerebral hematoma volume (by computed tomography brain scan) at 24 hours
时间窗: At 24 hours
Intracerebral hematoma volume (ml) as assessed by CT brain scan.
Intracerebral hematoma volume (by computed tomography brain scan) at 1 week
时间窗: At 1 week
Intracerebral hematoma volume (ml) as assessed by CT brain scan.
次要结局
- Glasgow outcome score(At 3-months and 6 months after stroke)
- 30-day mortality(At 30 days after admission or until time of death within 30 days)
- Vascular occlusive events(At 30 days after admission)
- Rate of seizures(At 30 days after stroke)
- Tranexamic acid-associated adverse effects(At 30 days after admission)
- Need for neurosurgical intervention(At 30 days after admission)
- Modified Rankin score(At 3-months and 6 months after stroke)
- Stroke-specific quality of life scale(At 3-months and 6 months after stroke)
研究者
Peter Woo Yat Ming
Doctor
Kwong Wah Hospital