Ultra-Early and Short-Term Tranexamic Acid Treatment in Patients With Good- and Poor-Grade Aneurysmal Subarachnoid Hemorrhage

被引：0

作者：

Tjerkstra, Maud A. ^{[1
]}

Post, Rene ^{[1
]}

Germans, Menno R. ^{[2
]}

Vergouwen, Mervyn D. I. ^{[3
]}

Jellema, Korne ^{[4
]}

Koot, Radboud W. ^{[6
]}

Kruyt, Nyika D. ^{[7
]}

Wolfs, Jasper F. C. ^{[5
]}

De Beer, Frits C. ^{[8
]}

Kieft, Hans H. ^{[9
]}

Nanda, Dharmin ^{[8
]}

van der Pol, Bram ^{[10
]}

Roks, Gerwin ^{[11
]}

De Beer, Frank ^{[12
,18
]}

Reichman, Loes J. A. ^{[13
]}

Brouwers, Paul J. A. M. ^{[14
]}

Kwa, Vincent I. H. ^{[15
]}

van der Ree, Taco C. ^{[16
]}

Bienfait, Henri P. ^{[17
]}

Boogaarts, Hieronymus D.

Klijn, Catharina J. ^{[19
]}

Visser, Victoria ^{[1
]}

van den Berg, Rene ^{[20
]}

Coert, Bert A. ^{[1
]}

Horn, Janneke ^{[21
]}

Majoie, Charles B. L. M. ^{[20
]}

Rinkel, Gabriel J. E. ^{[3
]}

Roos, Yvo B. W. E. M. ^{[22
]}

Vandertop, W. Peter ^{[1
]}

Verbaan, Dagmar ^{[1
]}

机构：

[1] Univ Amsterdam, Amsterdam UMC, Dept Neurosurg, Amsterdam, Netherlands

[2] Univ Hosp Zurich, Clin Neurosci Ctr, Dept Neurosurg, Zurich, Switzerland

[3] Univ Med Ctr Utrecht, UMC Utrecht Brain Ctr, Dept Neurol & Neurosurg, Utrecht, Netherlands

[4] Haaglanden Med Ctr, Dept Neurol, The Hague, Netherlands

[5] Haaglanden Med Ctr, Dept Neurosurg, The Hague, Netherlands

[6] Leiden Univ, Med Ctr, Dept Neurosurg, Leiden, Netherlands

[7] Leiden Univ, Med Ctr, Dept Neurol, Leiden, Netherlands

[8] ISALA Hosp, Dept Neurosurg, Zwolle, Netherlands

[9] ISALA Hosp, Dept Intens Care, Zwolle, Netherlands

[10] Elisabeth Tweesteden Ziekenhuis, Dept Neurosurg, Tilburg, Netherlands

[11] Elisabeth Tweesteden Ziekenhuis, Dept Neurol GR, Tilburg, Germany

[12] Spaarne Gasthuis, Dept Neurol, Haarlem, South Africa

[13] Ziekenhuisgroep Twente, Dept Neurol, Almelo, Netherlands

[14] Med Spectrum Twente, Dept Neurol, Enschede, Netherlands

[15] OLVG, Dept Neurol VIHK, Amsterdam, Netherlands

[16] Dijklander Hosp, Dept Neurol, Hoorn, Netherlands

[17] Gelre Hosp, Dept Neurol, Apeldoorn, Netherlands

[18] Radboud Univ Nijmegen Med Ctr, Dept Neurosurg, Nijmegen, Netherlands

[19] Radboud Univ Nijmegen, Med Ctr, Donders Inst Brain, Dept Neurol Cognit & Behav, Nijmegen, Netherlands

[20] Univ Amsterdam, Dept Radiol & Nucl Med, Amsterdam, Netherlands

[21] Univ Amsterdam, Dept Intens Care, Amsterdam, Netherlands

[22] Univ Amsterdam, Amsterdam UMC, Dept Neurol, Amsterdam, Netherlands

来源：

NEUROLOGY | 2024年 / 102卷 / 12期

关键词：

D O I：

10.1212/WNL.0000000000209169

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Objectives The results of the ULTRA trial showed that ultra-early and short-term treatment with tranexamic acid (TXA) does not improve clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH). Possibly, the lack of a beneficial effect in all patients with aSAH is masked by antagonistic effects of TXA in certain subgroups. In this post hoc subgroup analysis, we investigated the effect of TXA on clinical outcome in patients with good-grade and poor-grade aSAH. Methods The ULTRA trial was a multicenter, prospective, randomized, controlled, open-label trial with blinded outcome assessment. Participants received ultra-early and short-term TXA in addition to usual care or usual care only. This post hoc subgroup analysis included only ULTRA participants with confirmed aSAH and available World Federation of Neurosurgical Societies (WFNS) grade on admission. Patients were categorized into those with good-grade (WFNS 1-3) and poor-grade (WFNS 4-5) aSAH. The primary outcome was clinical outcome assessed by the modified Rankin scale (mRS). Odds ratios (ORs) and adjusted ORs (aORs) with 95% CIs were calculated using ordinal regression analyses. Analyses were performed using the as-treated principle. In all patients with aSAH, no significant effect modification of TXA on clinical outcome was observed for admission WFNS grade (p = 0.10). Results Of the 812 ULTRA participants, 473 patients had (58%; N = 232 TXA, N = 241 usual care) good-grade and 339 (42%; N = 162 TXA, N = 176 usual care) patients had poor-grade aSAH. In patients with good-grade aSAH, the TXA group had worse clinical outcomes (OR: 0.67, 95% CI 0.48-0.94, aOR 0.68, 95% CI 0.48-0.94) compared with the usual care group. In patients with poor-grade aSAH, clinical outcomes were comparable between treatment groups (OR: 1.04, 95% CI 0.70-1.55, aOR 1.05, 95% CI 0.70-1.56). Discussion This post hoc subgroup analysis provides another important argument against the use of TXA treatment in patients with aSAH, by showing worse clinical outcomes in patients with good-grade aSAH treated with TXA and no clinical benefit of TXA in patients with poor-grade aSAH, compared with patients treated with usual care.

引用

页数：10

共 50 条

[1] Ultra-Early Surgery for Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study
Pan, Jian-Wei
Zhan, Ren-Ya
Wen, Liang
Tong, Ying
Wan, Shu
Zhou, Yong-Ying
YONSEI MEDICAL JOURNAL, 2009, 50 (04) : 521 - 524
[2] Ultra-Early Treatment for Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
Han, Yangyun
Ye, Feng
Long, Xiaodong
Li, Aiguo
Xu, Hong
Zou, Linbo
Yang, Yumin
You, Chao
WORLD NEUROSURGERY, 2018, 115 : E160 - E171
[3] Ultra-early induction of brain hypothermia for patients with poor-grade subarachnoid hemorrhage
Kobata, H
Sugie, A
Nishihara, I
Fukumoto, H
Morita, H
HYPOTHERMIA FOR ACUTE BRAIN DAMAGE: PATHOMECHANISM AND PRACTICAL ASPECTS, 2004, : 215 - 219
[4] SHORT-TERM TRANEXAMIC ACID TREATMENT IN ANEURYSMAL SUBARACHNOID HEMORRHAGE
WIJDICKS, EFM
HASAN, D
LINDSAY, KW
BROUWERS, PJAM
HATFIELD, R
MURRAY, GD
VANGIJN, J
VERMEULEN, M
STROKE, 1989, 20 (12) : 1674 - 1679
[5] Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage
Kaneko, Tanya
Tagami, Takashi
Unemoto, Kyoko
Tanaka, Chie
Kuwamoto, Kentaro
Sato, Shin
Tani, Shosei
Shibata, Ami
Kudo, Saori
Kitahashi, Akiko
Yokota, Hiroyuki
JOURNAL OF NIPPON MEDICAL SCHOOL, 2019, 86 (02) : 81 - 90
[6] Early coil embolization in the treatment of poor-grade patients with aneurysmal subarachnoid hemorrhage
Chamorro, C
Romera, MA
Silva, JA
Nombeia, L
Pardo, C
Vega, A
Ley, L
INTENSIVE CARE MEDICINE, 2001, 27 : S272 - S272
[7] THE EFFECTS OF ULTRA-EARLY CLIPPING ON SURVIVAL AND NEUROLOGICAL OUTCOME IN POOR-GRADE ANEURYSMAL SUBARACHNOID HAEMORRHAGE
Simsek, Osman
Akinci, Ahmet Tolgay
IDEGGYOGYASZATI SZEMLE-CLINICAL NEUROSCIENCE, 2022, 75 (9-10): : 325 - 332
[8] Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage
Hoogmoed, Jantien
Coert, Bert A.
van den Berg, Reno
Roos, Yvo B. W. E. M.
Horn, Janneke
Vandertop, W. Peter
Verbaan, Dagmar
WORLD NEUROSURGERY, 2018, 119 : E568 - E573
[9] Therapeutic hypothermia in patients with poor-grade aneurysmal subarachnoid hemorrhage
Won, So Young
Kim, Mi Kyung
Song, Jihye
Lim, Yong Cheol
CLINICAL NEUROLOGY AND NEUROSURGERY, 2022, 221
[10] Long-Term Outcomes of Elderly Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage
Yoshikawa, Shinichiro
Kamide, Tomoya
Kikkawa, Yuichiro
Suzuki, Kaima
Ikeda, Toshiki
Kohyama, Shinya
Kurita, Hiroki
WORLD NEUROSURGERY, 2020, 144 : E743 - E749

← 1 2 3 4 5 →