Tranexamic acid in spontaneous intracerebral hemorrhage: an updated systematic review and meta-analysis of randomized controlled trials.
Cuilin Que, Luda Feng, Xinxing Lai et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials assessed tranexamic acid (TXA) for spontaneous intracerebral hemorrhage. Nine trials initially enrolled 3,124 patients. Compared with control, TXA was not associated with significant differences in all-cause mortality (RR, 1.03; 95% CI [0.89-1.18]), hematoma expansion, functional independence, neurological impairment, or activities of daily living. Pooled results showed a reduction in hematoma volume from baseline (MD, -1.74; 95% CI [-2.47 to -1.02]), but adverse events did not differ significantly between groups.
Key findings
- All-cause mortality did not differ significantly with TXA (RR, 1.03; 95% CI [0.89-1.18]).
- TXA was not associated with significant differences in hematoma expansion (RR, 0.90; 95% CI [0.80-1.00]) or functional independence (RR, 1.02; 95% CI [0.92-1.12]).
- Hematoma volume decreased from baseline in pooled data (MD, -1.74; 95% CI [-2.47 to -1.02]).
- No significant difference in adverse events was observed between TXA and control groups.
Why it matters
The findings distinguish a reduction in hematoma volume from outcomes more directly relevant to patients, including survival and functional recovery. For spontaneous ICH, the pooled trial evidence did not show significant benefit in mortality, functional outcomes, or hematoma expansion, so the volume change alone should not be interpreted as evidence of improved clinical outcomes.
What to keep in mind
The abstract does not report further limitations; the findings are based on pooled randomized trials and should be interpreted in light of the reported confidence intervals.