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TOPLINE
Ultra-early, short-term use of tranexamic acid (TXA) after aneurysmal subarachnoid hemorrhage (aSAH) was associated with worse clinical outcomes at 6 months compared with usual care in men but showed no significant association with outcomes in women, a study showed.
METHODOLOGY
- Post hoc analysis of the ULTRA randomized controlled trial examined potential sex-specific effects of TXA in patients with aSAH.
- A total of 812 adults (577 women) with confirmed aSAH were included from 24 hospitals across Netherlands.
- Patients were randomly assigned to receive either TXA (1 g intravenous bolus followed by 1 g every 8 hours for maximum 24 hours or until aneurysm treatment) along with usual care (n = 395), or usual care alone (n = 417).
- The primary outcome was clinical outcome at 6 months, assessed using the modified Rankin Scale (mRS) score.
- Secondary outcomes classified clinical outcome as good (mRS score, 0-3), poor (mRS score, 4-6), excellent (mRS score, 0-2), or non-excellent (mRS score, 3-6). Researchers also assessed all-cause mortality at 30 days and 6 months and in-hospital complications.
TAKEAWAY
- In men, after adjusting for treatment center, Fisher grade score on first non-contrast head CT and anticoagulation use, TXA use was associated with nearly double the odds of worse clinical outcomes at 6 months (adjusted odds ratio [aOR], 1.94; P = .007) compared to no TXA use.
- In women, after adjusting for treatment center, TXA use showed no significant association with clinical outcomes at 6 months.
- No significant differences were observed in secondary outcomes, all-cause mortality, or in-hospital complications with TXA use vs no TXA use in men or women.
IN PRACTICE
"These findings show that routine use of TXA cannot be recommended in either females or males," the authors wrote.
SOURCE
The study was led by Raoul J. Koopmans, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands. It was published online on August 19 in the Journal of Neurology.
LIMITATIONS
The aSAH population was subdivided by sex, resulting in smaller sample sizes and reduced statistical power for detecting interaction effects, increasing the possibility of chance findings. By selecting only a subset of participants from the ULTRA trial, randomization was undone. Netherlands' small geographic size and high density of treatment centers may have resulted in earlier admission and treatment times, potentially reducing rebleeding risk and limiting the generalizability of the findings to other healthcare systems.
DISCLOSURES
The study was funded by Fonds NutsOhra. Some authors reported having financial or other ties with various organizations. Detailed disclosures are provided in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
