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21 March 2013
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| [ Print-friendly version ] |
| Tranexamic acid for IntraCerebral Haemorrhage TICH-2 |
| ISRCTN | ISRCTN93732214 |
| DOI | 10.1186/ISRCTN93732214 |
| ClinicalTrials.gov identifier | |
| EudraCT number | 2012-004108-37 |
| Public title | Tranexamic acid for IntraCerebral Haemorrhage TICH-2 |
| Scientific title | Tranexamic acid for IntraCerebral Haemorrhage TICH-2: a pragmatic phase III prospective double blind randomised placebo controlled trial |
| Acronym | TICH-2 |
| Serial number at source | HTA: 11/129/109, 13467 |
| Study hypothesis |
When someone has a stroke caused by bleeding into the brain (haemorrhagic stroke) permanent brain damage can occur and result in long term disability. There is also a chance that the bleeding can increase, which may cause worse disability or be life threatening. At present there is no effective treatment available to reduce the bleeding in the brain and improving the recovery. New treatments are being developed to treat stroke, but it can be very hard to test whether they work in the first few hours because often patients take longer than this to get to hospital and have investigations such as brain scanning. Also some treatments are not suitable for all patients.
In this trial, the aim is to test whether it is possible to give tranexamic acid to patients in the first few hours after a haemorrhagic stroke and find out if it reduces the chances of dying and being left with disability. Tranexamic acid encourages blood to clot to stop bleeding. Continued or increased bleeding into the brain (so called haematoma expansion) is not uncommon in the first hours and days following a haemorrhagic stroke and increases the risk of the patient not recovering fully and being left with some disability, or dying. Stopping the bleeding in the first hours after stroke with medications might help patients to recover better and reduce the number of patients who die. The data will help doctors decide whether blood thickening treatments like tranexamic acid can be used in patients with acute haemorrhagic strokes to try and reduce death and disability and improve recovery. Pilot study registered under ISRCTN50867461: http://www.controlled-trials.com/ISRCTN50867461 More details can be found at: http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=13467 More details can be found at http://www.hta.ac.uk/2943 |
| Lay summary |
Background and study aims
When someone has a stroke caused by bleeding into the brain (haemorrhagic stroke) permanent brain damage can occur and result in long term disability. There is also a chance that the bleeding can increase, which may cause worse disability or be life threatening. This happens in approximately 20-30% of haemorrhagic stroke patients. At present there is no available treatment that is effective at reducing the bleeding in the brain and improving the recovery. In this trial, we want to test whether it is possible to give a drug (tranexamic acid) to people in the first few hours after a haemorrhagic stroke. We hope that we will be able to show that giving the drug may reduce the chances of dying and being left with disability after a haemorrhagic stroke. In this trial, the treatment we are testing is a drug, tranexamic acid, which encourages blood to clot to stop bleeding. Continued or increased bleeding into the brain (haematoma expansion) is not uncommon in the first hours and days following a haemorrhagic stroke and increases the risk of the patient not recovering fully and being left with some disability. Stopping the bleeding in the first hours and days after stroke with medicine might help patients to recover better. Tranexamic acid is a tried and tested drug in other medical conditions that acts quickly to help the blood to clot and stop bleeding but is not given routinely after stroke. We aim to assess in this trial what effect tranexamic acid has on how people recover after a haemorrhagic stroke. Who can participate? Adults with an acute stroke caused bleeding in the brain, within 8 hours of the stroke onset. Participants will need to be able to complete all of the assessments, and will not have a diagnosis of another medical condition that is likely to interfere with the trial (e.g. terminal illness or pregnancy). Participants cannot be participating in other trials that are testing drugs. What does the study involve? Each participant’s involvement in the study will last for 90 days. We select which treatment you receive randomly (like tossing a coin) because this is how most clinical trials are carried out. Half the participants will receive the drug tranexamic acid injection and half will have an injection of salt water as a dummy (placebo) treatment. The treatment (either tranexamic acid or dummy) will be given as an injection as soon as possible once participants have decided they wish to take part in the study. The treatment will be given via a drip over approximately 8 hours. You will not know if you received the drug or the dummy. The treatment will be given once, and then the treatment will stop. During the next 7 days a nurse will check the participant’s condition looking in particular for signs of side effects of the treatment. We will also repeat a brain scan the day after the treatment to assess effects of the treatment. We will ask your permission to contact participants GP or check with the NHS Information Centre to check on the participant’s condition three months after the stroke and to confirm contact details. The participant will then be contacted for a telephone consultation with a member of the research team. It will involve asking how the participant feels life has been affected by the stroke and some brief memory tests. What are the possible benefits and risks of participating? Because tranexamic acid is already routinely used in a number of bleeding conditions, we expect the potential benefit of the drug (stopping bleeding in to the brain) to outweigh the low risk of serious side effects (such as blood clots). However we do not know this for certain and will monitor all participants closely for side effects. Treatment with any drugs can result in possible side effects, but the side effects from tranexamic acid are generally mild. They can include diarrhoea, low blood pressure and dizziness. The drug can also sometimes affect colour vision but this is rare. However, because the treatment works by stopping bleeding there is a chance it can cause an increase in blood clot formation. This can occur in the legs (deep vein thrombosis, DVT) or the lungs (Pulmonary embolism, PE) and is potentially very serious and maybe even life threatening. In a very large study in 20,000 people with serious bleeding, tranexamic acid was safe and reduced the number of people dying from bleeding. There was no increase in serious side effects, such as blood clots, in the patients who were treated with tranexamic acid. Where is the study run from? The study is being run from the University of Nottingham, Division of Stroke but is a multi centre trial, with centres in the UK and worldwide. When is the study starting and how long is it expected to run for? The study will be recruiting 2000 participants over 4 years, between March 2013 and Feb 2017. Who is funding the study? The National Institute of Health Research (NIHR). Who is the main contact? Dr. Nikola Sprigg nikola.sprigg@nottingham.ac.uk |
| Ethics approval | NRES Committee East Midlands - Nottingham 2, 23rd November 2012, ref: 12/EM/0369 |
| Study design | Pragmatic phase III prospective double blind randomised placebo controlled trial |
| Countries of recruitment | Australia, Denmark, Egypt, Hong Kong, India, New Zealand, Poland, Romania, Sri Lanka, Sweden, United Kingdom |
| Disease/condition/study domain | Stroke |
| Participants - inclusion criteria | Adult (≥18 years, either sex) patients with acute primary intracerebral haemorrhage (PICH) within 8 hours of stroke onset. (Where stroke onset time is unknown, the time of when last known well will be used.) |
| Participants - exclusion criteria |
1. Patients with intracerebral haemorrhage secondary to anticoagulation, thrombolysis or known underlying structural abnormality such as arterial venous malformation, aneurysm, tumour, venous thrombosis as cause for the intracerebral haemorrhage. Note it is not necessary to exclude an underlying abnormality prior to enrolment, but where a secondary cause of haemorrhage is known, these patients should not be recruited.
2. Patients for whom tranexamic acid is thought to be contraindicated 3. Patients with premorbid dependency (mRS>4) 4. Participation in another drug trial concurrently 5. Prestroke life expectancy <3 months (e.g. advanced metastatic cancer) 6. Coma – Glasgow coma scale <5 |
| Anticipated start date | 01/02/2013 |
| Anticipated end date | 01/10/2016 |
| Status of trial | Ongoing |
| Patient information material | Not available in web format, please use the contact details below to request a patient information sheet |
| Target number of participants | UK Sample Size: 1300 |
| Interventions | Intravenous tranexamic acid: 1g loading dose given as 100 mls infusion over 10 minutes, followed by another 1g in 250 mls infused over 8 hours. Comparator – matching placebo (normal saline 0.9%) administered by identical regimen. |
| Primary outcome measure(s) |
Tranexamic acid, To assess whether tranexamic acid is safe and reduces death or dependency after primary intracerebral haemorrhage (PICH)
Death or dependency (ordinal shift on mRS) at day 90 will be analysed by intention-to-treat using ordinal logistic regression (OLR), with adjustment for minimisation factors. The assumption of proportional odds will be tested using the likelihood ratio test. Comparison of tranexamic acid versus control. |
| Secondary outcome measure(s) |
At day 7 (or discharge if sooner), neurological impairment (NIHSS).
At day 90, disability (Barthel index), Quality of Life (EuroQol), cognition, cognition and mood (TICS and ZDS). Safety: death, serious adverse events, thromboembolic events, seizures. Costs: length of stay in hospital, re-admission, institutionalisation. Radiological efficacy/safety (CT scan): change in haematoma volume from baseline to 24 hours, haematoma location, and new infarction. |
| Sources of funding | NIHR Health Technology Assessment - (HTA) (UK) grant ref: 11/129/109 |
| Trial website | http://tich-2.org/ |
| Publications | |
| Contact name | Ms Nikola Sprigg |
| Address | University Park |
| City/town | Nottingham |
| Zip/Postcode | NG7 2RD |
| Country | United Kingdom |
| nikola.sprigg@nottingham.ac.uk | |
| Sponsor | University of Nottingham (UK) |
| Address |
Research Innovation Services
King’s Meadow Campus Lenton Lane |
| City/town | Nottingham |
| Zip/Postcode | NG7 2NR |
| Country | United Kingdom |
| sponsor@nottingham.ac.uk | |
| Sponsor website: | http://www.nottingham.ac.uk/ |
| Date applied | 15/01/2013 |
| Last edited | 06/03/2013 |
| Date ISRCTN assigned | 17/01/2013 |
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