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Tranexamic acid for intracerebral haemorrhage within 2 hours of onset: protocol of a phase II randomised placebo-controlled double-blind multicentre trial

journal contribution
posted on 2022-04-01, 00:00 authored by N Yassi, H Zhao, L Churilov, B C V Campbell, T Wu, H Ma, A Cheung, T Kleinig, H Brown, P Choi, J S Jeng, A Ranta, H K Wang, G C Cloud, R S Grimley, D Shah, N Spratt, D Y Cho, K Mahawish, L Sanders, J Worthington, Ben ClissoldBen Clissold, A Meretoja, V Yogendrakumar, M D Ton, D P Dang, N T M Phuong, H T Nguyen, C Y Hsu, G Sharma, P J Mitchell, B Yan, M W Parsons, C R Levi, G Donnan, S Davis
RationaleHaematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth.Methods and designStopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework.HypothesisIn patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo.Sample size estimatesA sample size of 180 patients (90 in each arm) would be required to detect an absolute difference in the primary outcome of 20% (placebo 39% vs treatment 19%) under a two-tailed significance level of 0.05. An adaptive sample size re-estimation based on the outcomes of 144 patients will allow a possible increase to a prespecified maximum of 326 patients.InterventionParticipants will receive 1 g intravenous tranexamic acid over 10 min, followed by 1 g intravenous tranexamic acid over 8 hours; or matching placebo.Primary efficacy measureThe primary efficacy measure is the proportion of patients with haematoma growth by 24±6 hours, defined as either ≥33% relative increase or ≥6 mL absolute increase in haematoma volume between baseline and follow-up CT scan.DiscussionWe describe the rationale and protocol of STOP-MSU, a phase II trial of tranexamic acid in patients with ICH within 2 hours from onset, based in participating mobile stroke units and emergency departments.

History

Journal

Stroke and vascular neurology

Volume

7

Issue

2

Pagination

158 - 165

Publisher

BMJ PUBLISHING GROUP

Location

England

ISSN

2059-8688

eISSN

2059-8696

Language

English

Publication classification

C2 Other contribution to refereed journal

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