Tranexamic Acid with Intensive Blood Pressure Management in Ultra-Early Intracerebral Hemorrhage

Prior treatment

• Scheduled for surgical intervention (i.e., hematoma evacuation, craniectomy);
• Antihypertensive therapy contraindications;

Other illness

• Pre-illness mRS \> 2;
• Primary thalamic hemorrhage or intracerebral hemorrhage that has extended into the ventricles;
• Traumatic brain injury-related hemorrhage;
• Recent stroke, TIA, or thrombolytic therapy;
• Active thrombosis or thromboembolic history;
• Epilepsy history;
• Allergy to TXA or antifibrinolytics;

Lab values

• Blood disorders, platelets \<50,000/µL, or INR ≥1.8;
• GFR \<90 mL/min;
• Elevated ALT or liver disease;

Other

• Secondary ICH from tumors, AVMs, and aneurysms;
• On anticoagulants;
• Indications for immediate blood pressure reduction;
• Hereditary or acquired thrombophilia;
• Acquired color vision deficiency;
• Life expectancy \<12 months;
• Pregnant or lactating women;
• In other interventional clinical trials;
• Other investigator-defined ineligibilities.

• Age between 18 to 80 years old;
• A definite diagnosis of supratentorial brain parenchymal hemorrhage by non-contrast cranial CT scan;
• Hemorrhage volume less than 40 mL, as calculated using the ABC/2 method, with ultra-early hemorrhage growth (uHG) 10 mL/h or higher;
• A clear time of symptom onset, and the randomization must occur within 2 hours from the onset;
• At least two measurements of systolic blood pressure that are ≥150 mmHg and \<220 mmHg, with at least a 2-minute interval between measurements.;
• Baseline NIHSS of 8 or higher, or unilateral limb muscle strength of 0-3 grades;
• GCS score greater than 8;
• The patient or their legal representative has signed an informed consent form.