{
  "abstract": "Background Spontaneous intracerebral haemorrhage (ICH) has high rates of mortality with no proven haemostatic treatment. We conducted the first systematic review and individual patient data meta-analysis (IPDMA) to assess the effect of tranexamic acid on outcomes in spontaneous ICH.Methods We searched databases such as MEDLINE, EMBASE and CENTRAL for randomised controlled trials comparing intravenous tranexamic acid to placebo in adults with spontaneous ICH treated within 12 hours. The primary outcome was 90-day functional status (modified Rankin scale). Secondary outcomes included early mortality and haematoma expansion. One-stage random-effects analysis used generalised linear mixed models. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 tool.Results We screened 1131 records; nine trials (3194 participants) met inclusion and five trials (2860 participants; 90%) provided individual patient data. ROB was low in all trials. At 90 days, 53.2% of patients receiving tranexamic acid had a worse functional outcome compared with 53.6% in the placebo (adjusted common OR 0.93, 95% CI 0.81 to 1.07). Mortality at day 7 and haematoma expansion were significantly reduced with tranexamic acid (adjusted OR 0.70, 95% CI 0.51 to 0.95; and OR 0.81, 95% CI 0.68 to 0.97). No between-trial heterogeneity was observed.Conclusions This systematic review and IPDMA of tranexamic acid for spontaneous ICH found no improvement in 90-day functional outcomes. However, small yet significant reductions in early mortality and haematoma expansion were observed. The early mortality benefit and favourable safety profile support further research into ultra-early treatment and as part of ICH care bundles for selected patient populations.PROSPERO registration number CRD42017054978.",
  "authors": [
    {
      "affiliations": [
        "Stroke Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Chaamanti Sivakumar Menon"
    },
    {
      "affiliations": [
        "Department of Medicine, National University of Malaysia Faculty of Medicine, Cheras, Malaysia",
        "Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK"
      ],
      "name": "Zhe Kang Law"
    },
    {
      "affiliations": [
        "Stroke, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK"
      ],
      "name": "Lisa Jane Woodhouse"
    },
    {
      "affiliations": [
        "Neurology, Beijing Tiantan Hospital, Beijing, China"
      ],
      "name": "Jingyi Liu"
    },
    {
      "affiliations": [
        "Department of Medicine, Melbourne Brain Centre, Parkville, Victoria, Australia"
      ],
      "name": "Chloe Mutimer"
    },
    {
      "affiliations": [
        "Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Michael Desborough"
    },
    {
      "affiliations": [
        "Neurology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China"
      ],
      "name": "Liping Liu"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Alexandros A Polymeris"
    },
    {
      "affiliations": [
        "Helsinki University Central Hospital, Helsinki, Finland"
      ],
      "name": "Atte Meretoja"
    },
    {
      "affiliations": [
        "The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia"
      ],
      "name": "Nawaf Yassi"
    },
    {
      "affiliations": [
        "Department of Medicine, Melbourne Brain Centre, Parkville, Victoria, Australia"
      ],
      "name": "Henry Zhao"
    },
    {
      "affiliations": [
        "Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Stephen Davis"
    },
    {
      "affiliations": [
        "Melbourne Medical School, Melbourne Brain Centre, Parkville, Victoria, Australia",
        "Melbourne Brain Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Geoffrey A Donnan"
    },
    {
      "affiliations": [
        "Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK"
      ],
      "name": "Robert A Dineen"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland",
        "Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK"
      ],
      "name": "David J Seiffge"
    },
    {
      "affiliations": [
        "Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India"
      ],
      "name": "Jeyaraj D Pandian"
    },
    {
      "affiliations": [
        "Centre for Clinical Brain Sciences, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK"
      ],
      "name": "Rustam Al-Shahi Salman"
    },
    {
      "affiliations": [
        "Stroke Trials Unit, University of Nottingham, Nottingham, UK"
      ],
      "name": "Philip M Bath"
    },
    {
      "affiliations": [
        "Stroke, University of Nottingham Division of Stroke, Nottingham, UK"
      ],
      "name": "Nikola Sprigg"
    }
  ],
  "title": "Effect of tranexamic acid for acute spontaneous intracerebral haemorrhage: a systematic review and individual patient data meta-analysis",
  "uid": "b44e626f-166a-55ab-afeb-dd249e573688"
}