scholarly journals Tranexamic Acid for Prevention of Hematoma Expansion in Intracerebral Hemorrhage Patients With or Without Spot Sign

Stroke ◽  
2021 ◽  
Author(s):  
Christian Ovesen ◽  
Janus Christian Jakobsen ◽  
Christian Gluud ◽  
Thorsten Steiner ◽  
Zhe Law ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
Main Trial ◽  
Acid Versus ◽  
Acute Intracerebral Hemorrhage

Background and Purpose: The computed tomography angiography or contrast-enhanced computed tomography based spot sign has been proposed as a biomarker for identifying on-going hematoma expansion in patients with acute intracerebral hemorrhage. We investigated, if spot-sign positive participants benefit more from tranexamic acid versus placebo as compared to spot-sign negative participants. Methods: TICH-2 trial (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) was a randomized, placebo-controlled clinical trial recruiting acutely hospitalized participants with intracerebral hemorrhage within 8 hours after symptom onset. Local investigators randomized participants to 2 grams of intravenous tranexamic acid or matching placebo (1:1). All participants underwent computed tomography scan on admission and on day 2 (24±12 hours) after randomization. In this sub group analysis, we included all participants from the main trial population with imaging allowing adjudication of spot sign status. Results: Of the 2325 TICH-2 participants, 254 (10.9%) had imaging allowing for spot-sign adjudication. Of these participants, 64 (25.2%) were spot-sign positive. Median (interquartile range) time from symptom onset to administration of the intervention was 225.0 (169.0 to 310.0) minutes. The adjusted percent difference in absolute day-2 hematoma volume between participants allocated to tranexamic versus placebo was 3.7% (95% CI, −12.8% to 23.4%) for spot-sign positive and 1.7% (95% CI, −8.4% to 12.8%) for spot-sign negative participants ( P heterogenity =0.85). No difference was observed in significant hematoma progression (dichotomous composite outcome) between participants allocated to tranexamic versus placebo among spot-sign positive (odds ratio, 0.85 [95% CI, 0.29 to 2.46]) and negative (odds ratio, 0.77 [95% CI, 0.41 to 1.45]) participants ( P heterogenity =0.88). Conclusions: Data from the TICH-2 trial do not support that admission spot sign status modifies the treatment effect of tranexamic acid versus placebo in patients with acute intracerebral hemorrhage. The results might have been affected by low statistical power as well as treatment delay. REGISTRATION: URL: http://www.controlled-trials.com ; Unique identifier: ISRCTN93732214.

Tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign trial: Rationale and design

2017 ◽  
Vol 12 (3) ◽  
pp. 326-331 ◽  
Author(s):  
Liping Liu ◽  
Yilong Wang ◽  
Xia Meng ◽  
Na Li ◽  
Ying Tan ◽  
...  
Keyword(s):  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Primary Outcome Measure ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
Double Blind ◽  
Risk Patients ◽  
Acute Intracerebral Hemorrhage ◽  
Hemorrhage Volume

Rationale Acute intracerebral hemorrhage inflicts a high-economic and -health burden. Computed tomography angiography spot sign is a predictor of hematoma expansion, is associated with poor clinical outcome and is an important stratifying variable for patients treated with haemostatic therapy. Aims We aim to compare the effect of treatment with tranexamic acid to placebo for the prevention of hemorrhage growth in patients with high-risk acute intracerebral hemorrhage with a positive spot sign. Design The tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign (TRAIGE) is a prospective, multicenter, placebo-controlled, double-blind, investigator-led, randomized clinical trial that will include an estimated 240 participants. Patients with intracerebral hemorrhage demonstrating symptom onset within 8 h and with the spot sign as a biomarker for ongoing hemorrhage, and no contraindications for antifibrinolytic therapy, will be enrolled to receive either tranexamic acid or placebo. The primary outcome measure is the presence of hemorrhage growth defined as an increase in intracerebral hemorrhage volume >33% or >6 ml from baseline to 24 ± 2 h. The secondary outcomes include safety and clinical outcomes. Conclusion The TRAIGE trial evaluates the efficacy of haemostatic therapy with tranexamic acid in the prevention of hemorrhage growth among high-risk patients with acute intracerebral hemorrhage.

Quantitative assessment of local perfusion change in acute intracerebral hemorrhage areas with and without “dynamic spot sign” using CT perfusion imaging

2018 ◽  
Vol 60 (3) ◽  
pp. 367-373
Author(s):  
Fan Fu ◽  
Binbin Sui ◽  
Liping Liu ◽  
Yaping Su ◽  
Shengjun Sun ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Control Group ◽  
Regional Cerebral Blood ◽  
Spot Sign ◽  
Positive Group ◽  
Regional Cerebral Blood Volume ◽  
Acute Intracerebral Hemorrhage

Background Positive “dynamic spot sign” has been proven to be a potential risk factor for acute intracerebral hemorrhage (ICH) expansion, but local perfusion change has not been quantitatively investigated. Purpose To quantitatively evaluate perfusion changes at the ICH area using computed tomography perfusion (CTP) imaging. Material and Methods Fifty-three patients with spontaneous ICH were recruited. Unenhanced computed tomography (NCCT), CTP within 6 h, and follow-up NCCT were performed for 21 patients in the “spot sign”-positive group and 32 patients in the control group. Cerebral perfusion change was quantitatively measured on regional cerebral blood flow/regional cerebral blood volume (rCBF/rCBV) maps. Regions of interest (ROIs) were set at the “spot-sign” region and the whole hematoma area for “spot-sign”-positive cases, and at one of the highest values of three interested areas and the whole hematoma area for the control group. Hematoma expansion was determined by follow-up NCCT. Results For the “spot-sign”-positive group, the average rCBF (rCBV) values at the “spot-sign” region and the whole hematoma area were 21.34 ± 15.24 mL/min/100 g (21.64 ± 21.48 mL/100g) and 5.78 ± 6.32 mL/min/100 g (6.07 ± 5.45 mL/100g); for the control group, the average rCBF (rCBV) values at the interested area and whole hematoma area were 2.50 ± 1.83 mL/min/100 g (3.13 ± 1.96 mL/100g) and 3.02 ± 1.80 mL/min/100 g (3.40 ± 1.44 mL/100g), respectively. Average rCBF and rCBV values of the “spot-sign” region were significantly different from other regions ( P < 0.001; P = 0.004). The average volumes of hematoma expansion in the “spot-sign”-positive and control groups were 25.24 ± 19.38 mL and −0.41 ± 1.34 mL, respectively. Conclusion The higher perfusion change at ICH on CTP images may reflect the contrast extravasation and be associated with the hematoma expansion.

Abstract W P257: Predictors of the CT Angiography Spot Sign in Deep and Lobar Intracerebral Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Farid Radmanesh ◽  
Guido J Falcone ◽  
Christopher D Anderson ◽  
Thomas W Battey ◽  
Alison M Ayres ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Cerebral Amyloid Angiopathy ◽  
Symptom Onset ◽  
Hematoma Expansion ◽  
Amyloid Angiopathy ◽  
Spot Sign ◽  
Increased Risk ◽  
Cerebral Amyloid

Objectives: Intracerebral hemorrhage (ICH) patients with CT angiography (CTA) spot sign are at increased risk of hematoma expansion and poor outcome. Since ICH is often the acute manifestation of a chronic cerebral vasculopathy, we investigated whether different clinical or imaging characteristics predict spot sign presence in patients with different underlying vasculopathies. Using ICH location as a surrogate for hypertension-related ICH and cerebral amyloid angiopathy-related ICH, we identified risk factors associated with spot sign. METHODS: We retrospectively analyzed a prospective cohort of consecutive spontaneous ICH patients with available CTA. Spot sign presence was ascertained by two independent readers blinded to clinical data. We assessed potential predictors of spot sign be performing uni- and multivariable logistic regression, analyzing deep and lobar ICH separately. RESULTS: 649 patients were eligible, 291 (45%) deep and 358 (55%) lobar ICH. Median time from symptom onset to CTA was 4.5 (IQR 5.2) and 5.7 (IQR 7.4) hours in patients with deep and lobar ICH, respectively. At least one spot sign was present in 76 (26%) deep and 103 (29%) lobar ICH patients. In mutivariable logistic regression, independent predictors of spot sign in deep ICH were warfarin (OR 2.82 [95%CI 1.06-7.57]; p=0.03), time from symptom onset to CTA (OR 0.9 [95%CI 0.81-0.97]; p=0.02), and baseline ICH volume (OR 1.27 [95%CI 1.14-1.43]; p=2.5E-5; per 10 mL increase). Predictors of spot sign in lobar ICH were preexisting dementia (OR 2.7 [95%CI 1.15-6.43]; p=0.02), warfarin (OR 4.01 [95%CI 1.78-9.29]; p=0.009), and baseline ICH volume (OR 1.27 [95%CI 1.17-1.39]; p=5.4E-8; per 10 mL increase). As expected, spot sign presence was a strong predictor of hematoma expansion in both deep (OR 3.52 [95%CI 1.72-7.2]; p=0.0005) and lobar ICH (OR 6.53 [95%CI 3.23-13.44]; p=2.2E-7). CONCLUSIONS: The most potent associations with spot sign are shared by deep and lobar ICH, suggesting that ICH caused by different vasculopathic processes share biological features. The relationship between preexisting dementia and spot sign in lobar ICH, but not deep ICH, suggests that ICH occurring in the context of more advanced cerebral amyloid angiopathy may be more likely to have prolonged bleeding.

scholarly journals Clinical Applications of the Computed Tomography Angiography Spot Sign in Acute Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 3427-3432 ◽  
Author(s):  
H. Bart Brouwers ◽  
Joshua N. Goldstein ◽  
Javier M. Romero ◽  
Jonathan Rosand
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Computed Tomography Angiography ◽  
Clinical Applications ◽  
Spot Sign ◽  
Acute Intracerebral Hemorrhage

scholarly journals Evolution of Computed Tomography Angiography Spot Sign Is Consistent With a Site of Active Hemorrhage in Acute Intracerebral Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (1) ◽  
pp. 277-280 ◽  
Author(s):  
Dar Dowlatshahi ◽  
Jason K. Wasserman ◽  
Franco Momoli ◽  
William Petrcich ◽  
Grant Stotts ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Computed Tomography Angiography ◽  
Spot Sign ◽  
Active Hemorrhage ◽  
Acute Intracerebral Hemorrhage ◽  
A Site

scholarly journals CT Angiography “Spot Sign” Predicts Hematoma Expansion in Acute Intracerebral Hemorrhage

Stroke ◽  
2007 ◽  
Vol 38 (4) ◽  
pp. 1257-1262 ◽  
Author(s):  
Ryan Wada ◽  
Richard I. Aviv ◽  
Allan J. Fox ◽  
Demetrios J. Sahlas ◽  
David J. Gladstone ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
Acute Intracerebral Hemorrhage
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