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ESOC 2022 | TICH-NOAC: tranexamic acid for the treatment of novel oral anticoagulant-associated ICH

Philippe Lyrer, MD, and Nils Peters, MD, University Hospital and University of Basel, Basel, Switzerland, present the findings of the TICH-NOAC trial (NCT02866838): a randomized, placebo-controlled trial assessing the efficacy and safety of tranexamic acid (TXA) versus placebo for the treatment of novel direct oral anticoagulant (NOAC)-associated intracerebral hemorrhage (ICH). ICH in patients receiving oral anticoagulation is associated with high morbidity and mortality and no evidence-based treatment options are available. TXA is an antifibrinolytic agent shown to reduce hematoma expansion in studies of spontaneous ICH. The trial randomized 63 patients within 12 hours of symptom onset and treated them with TXA or placebo within 30 minutes of randomization. The primary study endpoint of hematoma expansion was negative, with rates of almost 50% in both arms. Rates of severe disability and death were also comparable in the treatment and placebo arms. Prespecified subgroup analyses identified several factors associated with the effect of TXA on hematoma expansion, including time-to-treatment and blood pressure. These data will inform future investigations of the role of TXA in NOAC-associated ICH. This interview took place at the ESOC 2022 congress in Lyon, France.