Impact of time to start of tranexamic acid treatment on rebleed risk and outcome in aneurysmal subarachnoid hemorrhage.
| Autor: | Germans MR; Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland., Tjerkstra MA; Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands., Post R; Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands., Brenner A; Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK., Vergouwen MD; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Rinkel GJ; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Roos YB; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands.; Department of Neurology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, The Netherlands., van den Berg R; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands.; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands., Coert BA; Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands., Vandertop WP; Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands., Verbaan D; Department of Neurosurgery, Amsterdam University Medical Centers Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, The Netherlands. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | European stroke journal [Eur Stroke J] 2024 Sep; Vol. 9 (3), pp. 658-666. Date of Electronic Publication: 2024 Apr 12. |
| DOI: | 10.1177/23969873241246591 |
| Abstrakt: | Introduction: The ULTRA-trial investigated effectiveness of ultra-early administration of tranexamic acid (TXA) in subarachnoid hemorrhage (SAH) and showed that TXA reduces the risk of rebleeding without concurrent improvement in clinical outcome. Previous trials in bleeding conditions, distinct from SAH, have shown that time to start of antifibrinolytic treatment influences outcome. This post-hoc analysis of the ULTRA-trial investigates whether the interval between hemorrhage and start of TXA impacts the effect of TXA on rebleeding and functional outcome following aneurysmal SAH. Patients and Methods: A post-hoc comparative analysis was conducted between aneurysmal SAH patients of the ULTRA-trial, receiving TXA and usual care to those receiving usual care only. We assessed confounders, hazard ratio (HR) of rebleeding and odds ratio (OR) of good outcome (modified Rankin Scale 0-3) at 6 months, and investigated the impact of time between hemorrhage and start of TXA on the treatment effect, stratified into time categories (0-3, 3-6 and >6 h). Results: Sixty-four of 394 patients (16.2%) in the TXA group experienced a rebleeding, compared to 83 of 413 patients (19.9%) with usual care only (HR 0.86, 95% confidence interval (CI): 0.62-1.19). Time to start of TXA modifies the effect of TXA on rebleeding rate ( p < 0.001), with a clinically non-relevant reduction observed only when TXA was initiated after 6 h (absolute rate reduction 1.4%). Tranexamic acid treatment showed no effect on good outcome (OR 0.96, 95% CI: 0.72-1.27) with no evidence of effect modification on the time to start of TXA ( p = 0.53). Discussion and Conclusions: This study suggests that the effect of TXA on rebleeding is modified by time to treatment, providing a protective, albeit clinically non-relevant, effect only when started after 6 h. No difference in functional outcome was seen. Routine TXA treatment in the aneurysmal SAH population, even within a specified time frame, is not recommended to improve functional outcome. Competing Interests: Declaration of Conflicting InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MDIV reports funding from the Dutch Heart Foundation (clinical established investigator grant number 2018T0769). RvdB reports grants from Cerenovus neurovascular, outside the submitted work; YBWEMR is a minor shareholder of Nico-Lab. All other authors declare no competing interests. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|