Tranexamic acid for intracerebral haemorrhage within 2 hours of onset: protocol of a phase II randomised placebo-controlled double-blind multicentre trial
Nawaf Yassi, Henry Zhao, Leonid Churilov, Bruce Campbell, Teddy Y. Wu, Henry Ma, Andrew Cheung, Timothy Kleinig, Helen Brown, Philip Choi, Jiann‐Shing Jeng, Annemarei Ranta, Hao‐Kuang Wang, Geoffrey Cloud, Rohan Grimley, Darshan Shah, Neil J. Spratt, Der‐Yang Cho, Karim Mahawish, Lauren Sanders, John Worthington, Benjamin Clissold, Atte Meretoja, Vignan Yogendrakumar, Mai Duy Ton, Dang Phuc Duc, Nguyen Thai My Phuong, Huy‐Thang Nguyen, Chung Y. Hsu, Gagan Sharma, Peter Mitchell, Bernard Yan, Mark Parsons, Christopher Levi, Geoffrey A. Donnan, Stephen M. Davis
Abstract
RATIONALE: Haematoma 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 DESIGN: Stopping 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. HYPOTHESIS: In patients with spontaneous ICH, treatment with tranexamic acid within 2 hours of onset will reduce haematoma expansion compared with placebo. SAMPLE SIZE ESTIMATES: A 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. INTERVENTION: Participants 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 MEASURE: The 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. DISCUSSION: We 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.