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Drug to treat bleeding may benefit haemorrhagic stroke patients

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Patients with stroke caused by intracerebral haemorrhage may benefit from receiving a drug currently used to treat blood loss from major trauma and bleeding after childbirth, suggests a trial.

Researchers found that giving tranexamic acid (TXA) to patients who had experienced intracerebral haemorrhage reduced the number of deaths in the early days following the stroke.

“Tranexamic acid is cheap – costing less than £15 per patient – and widely available”

Nikola Sprigg

It also found that both the amount of bleeding in the brain and number of associated serious complications were lower in the patients who had received the TXA treatment.

However, the trial found no difference in the number of people who were left disabled or had died at three months after their stroke.

The researchers said they believed further study was needed on larger groups of patients to enable them to fully understand the potential benefits.

The research, published in The Lancet, was also presented at the 4th European Stroke Conference in Gothenburg, Sweden, on 16 May.

It was led by researchers at the University of Nottingham and funded by the National Institute for Health Research Health Technology Assessment Programme.

They noted that 15% of all strokes were caused by haemorrhagic stroke, for which there was currently no specific treatment.

They highlighted that many patients would die within a few days of their stroke or often be left with debilitating disabilities, including paralysis and an inability to speak.

“The reduction in early deaths, bleeding on the brain and serious complications are signs this drug may be of benefit”

Nikola Sprigg

The drug was chosen for the new study after previous research showed that it was successful in stopping bleeding in people involved in road traffic accidents, said the researchers.

The five-year TICH-2 trial recruited more than 2,000 patients from 124 hospitals in 12 countries between 2013 and 2017.

Patients were randomly sorted into two groups – one received TXA within eight hours of their stroke and another was given a saline placebo.

In the UK, more than 80 hospitals took part in the study with support from the NIHR clinical research network.

CT scans were performed 24 hours after stroke and the progress of patients was monitored and measured at day two and day seven after their stroke. The final follow up was performed at 90 days.

TXA did not improve the outcome after 90 days, as there was no significant difference between the groups in the number of patients who subsequently died or were left with disabilities at three months.

However, in the TXA group there were fewer deaths by day seven following the stroke and, at day two, fewer people on TXA experienced a worsening of the bleed on their brain and had smaller amounts of blood in the brain compared to their control group counterparts.

Also, the number of patients who experienced associated serious complications, such as pneumonia and brain swelling, were lower in the patients who had received the TXA treatment compared to those who had control.

University of Nottingham

Professor Nikola Sprigg

Nikola Sprigg

In addition, the trial found evidence that TXA might be more effective in patients with lower blood pressure, as those with pressure under 170mmHg had a more favourable outcome than those above.

Lead study author Professor Nikola Sprigg, from the Stroke Trials Unit at Nottingham, said: “Tranexamic acid is cheap – costing less than £15 per patient – and widely available so has the potential for reducing death and disability across the world.”

“While we failed to show significant benefits three months after stroke, the reduction in early deaths, amount of bleeding on the brain and serious complications are signs that this drug may be of benefit in the future,” she said.

“More trials are needed, particularly focusing on giving treatment as soon as possible after the start of bleeding in this emergency condition,” said Professor Sprigg.

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