BACKGROUND/AIMS:
The STOP-MSU trial of tranexamic acid (TXA) versus placebo in intracerebral haemorrhage (ICH) <2h from onset found no benefit on haematoma expansion (HE) at 24-hours. Rapid blood pressure (BP) control is increasingly recognised as vital in the early management of ICH. We conducted a post-hoc analysis of STOP-MSU patients to describe BP dynamics, assess associations with HE, and compare BP trends between treatment groups.
METHODS:
We retrospectively reviewed participant files with adequate BP data within 24-hours of enrolment. BP management followed local protocols. We assessed the association between time-to-BP-control and 24h-HE using univariable logistic regression, stratified by randomisation group.
RESULTS:
Of 201 patients, 151 were included (median age 66years, 43.1% female, HE 34.8%). Median baseline systolic BP (SBP) was 167.5mmHg, and this was reduced by a median of ~13% within 4-hours. Of 126 (83.4%) patients with baseline SBP>150mmHg, 53.2% had SBP≤140mmHg by 4-hours and 88.9% by 24-hours. There were similar rates of HE between patients with and without SBP≤140mmHg at 4-hours (56.2% and 58.9% respectively). No differences in SBP≤140 mmHg were observed between TXA and placebo at baseline (90.1% and 90% respectively), 4-hours (55.6% and 61.4%) or 24-hours (6.2% and 14.2%). Time-to-BP-control was not associated with HE in either group (placebo: unOR0.99, 95%CI 0.93-1.06; TXA: unOR1.01, 95%CI 0.95-1.09).
CONCLUSIONS:
Systolic hypertension was very common at baseline, and only 50% of participants had SBP≤140 by 4-hours. Our study suggests that future antifibrinolytic trials should consider more stringent protocols for rapid BP control and prospective BP measurement within the trial protocol.