Tranexamic Acid in Non-Traumatic Intracerebral Haemorrhage (TANICH II): Introducing the Potential Role of 3 g Tranexamic Acid in Haematoma Reduction
Authors:   Department of Neurosurgery, Hospital Queen Elizabeth II, Sabah, Malaysia, Arumugam Ananda ,   Department of Neurosurgery, Hospital Queen Elizabeth I, Sabah, Malaysia, Shze Ee Tan ,   Department of Neurosurgery, Hospital Queen Elizabeth II, Sabah, Malaysia,   Department of Neurosurgery, Hospital Queen Elizabeth I, Sabah, Malaysia,   Department of Neurosciences, Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia, Sze Ling Tan ,   Department of Pharmacy, Hospital Queen Elizabeth II, Sabah, Malaysia, Jun Ee Tan ,   Department of Radiology, Hospital Queen Elizabeth I, Sabah, Malaysia, Hussin Fatimah @ Hartina ,   Department of Radiology, Hospital Queen Elizabeth I, Sabah, Malaysia, Zenian Mohd Sofan ,   Department of Neurosurgery, Hospital Queen Elizabeth II, Sabah, Malaysia,   Department of Neurosurgery, Hospital Queen Elizabeth I, Sabah, Malaysia, Idris Zamzuri ,   Department of Neurosciences, Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia, Abdullah Jafri Malin ,   Department of Neurosciences, Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
Published: June 2023

Background: Intracerebral haemorrhage (ICH) can be devastating, particularly if haematoma expansion occurs. The efficacy of tranexamic acid (TXA), an anti-fibrinolytic agent, in reducing haematoma expansion is now being studied worldwide. However, the optimal dosage of TXA has yet to be determined. This study was designed to further establish the potential of different doses of TXA. Methods: A double-blinded, randomised, placebo-controlled study was carried out among adults with non-traumatic ICH. Eligible study subjects were randomly assigned to receive placebo, 2-g TXA treatment or 3-g TXA treatment. Haematoma volumes before and after intervention were measured using the planimetric method. Results: A total of 60 subjects with 20 subjects in each treatment group were recruited for this study. Among the 60 subjects, the majority were male (n = 36, 60%), had known cases of hypertension (n = 43, 71.7%) and presented with full Glasgow coma scale (GCS) (n = 41, 68.3%). The results showed that there was no statistically significant difference (P = 0.315) in the mean changes of haematoma volume when compared with three study groups using ANCOVA, although the 3-g TXA group was the only group that showed haematoma volume reduction (mean reduction of 0.2 cm3) instead of expansion as in placebo (mean expansion 1.8 cm3) and 2-g TXA (mean expansion 0.3 cm3) groups. Good recovery was observed in all study groups, with only three subjects being moderately disabled. No adverse effects were reported in any of the study groups. Conclusion: To the best of our knowledge, this is the first clinical study using 3 g of TXA in the management of non-traumatic ICH. From our study, 3 g of TXA may potentially be helpful in reducing haematoma volume. Nonetheless, a larger-scale randomised controlled trial should be carried out to further establish the role of 3 g of TXA in non-traumatic ICH.