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5. Ultra-Early and Short-Term Tranexamic Acid Treatment in Patients With Good- and Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Author

Neurologen, Brain, Circulatory Health, Projectafdeling CVZ, Tjerkstra, Maud A., Post, René, Germans, Menno R., Vergouwen, Mervyn D.I., Jellema, Korne, Koot, Radboud W., Kruyt, Nyika D., Wolfs, Jasper F.C., De Beer, Frits C., Kieft, Hans H., Nanda, Dharmin, Van Der Pol, Bram, Roks, Gerwin, De Beer, Frank, Reichman, Loes J.A., Brouwers, Paul J.A.M., Kwa, Vincent I.H., Van Der Ree, Taco C., Bienfait, Henri P., Boogaarts, Hieronymus D., Klijn, Catharina J., Visser, Victoria, van den Berg, René, Coert, Bert A., Horn, Janneke, Majoie, Charles B.L.M., Rinkel, Gabriël J.E., Roos, Yvo B.W.E.M., Vandertop, W. Peter, Verbaan, Dagmar, ULTRA trial study group, Neurologen, Brain, Circulatory Health, Projectafdeling CVZ, Tjerkstra, Maud A., Post, René, Germans, Menno R., Vergouwen, Mervyn D.I., Jellema, Korne, Koot, Radboud W., Kruyt, Nyika D., Wolfs, Jasper F.C., De Beer, Frits C., Kieft, Hans H., Nanda, Dharmin, Van Der Pol, Bram, Roks, Gerwin, De Beer, Frank, Reichman, Loes J.A., Brouwers, Paul J.A.M., Kwa, Vincent I.H., Van Der Ree, Taco C., Bienfait, Henri P., Boogaarts, Hieronymus D., Klijn, Catharina J., Visser, Victoria, van den Berg, René, Coert, Bert A., Horn, Janneke, Majoie, Charles B.L.M., Rinkel, Gabriël J.E., Roos, Yvo B.W.E.M., Vandertop, W. Peter, Verbaan, Dagmar, and ULTRA trial study group

Published
2024

6. Impact of time to start of tranexamic acid treatment on rebleed risk and outcome in aneurysmal subarachnoid hemorrhage

Author

Neurologen, Brain, Circulatory Health, UMC Utrecht, Germans, Menno R., Tjerkstra, Maud A., Post, René, Brenner, Amy, Vergouwen, Mervyn D.I., Rinkel, Gabriël J.E., Roos, Yvo B.W.E.M., van den Berg, René, Coert, Bert A., Vandertop, W. Peter, Verbaan, Dagmar, Neurologen, Brain, Circulatory Health, UMC Utrecht, Germans, Menno R., Tjerkstra, Maud A., Post, René, Brenner, Amy, Vergouwen, Mervyn D.I., Rinkel, Gabriël J.E., Roos, Yvo B.W.E.M., van den Berg, René, Coert, Bert A., Vandertop, W. Peter, and Verbaan, Dagmar

Published
2024

7. Impact of time to start of tranexamic acid treatment on rebleed risk and outcome in aneurysmal subarachnoid hemorrhage

Author

Germans, Menno R; https://orcid.org/0000-0003-2185-4526, Tjerkstra, Maud A; https://orcid.org/0000-0001-9060-3435, Post, René; https://orcid.org/0000-0001-7844-6262, Brenner, Amy, Vergouwen, Mervyn DI; https://orcid.org/0000-0002-6823-1628, Rinkel, Gabriël Je, Roos, Yvo Bwem; https://orcid.org/0000-0001-9205-5882, van den Berg, René, Coert, Bert A, Vandertop, W Peter; https://orcid.org/0000-0001-5417-0265, Verbaan, Dagmar; https://orcid.org/0000-0002-9212-5470, Germans, Menno R; https://orcid.org/0000-0003-2185-4526, Tjerkstra, Maud A; https://orcid.org/0000-0001-9060-3435, Post, René; https://orcid.org/0000-0001-7844-6262, Brenner, Amy, Vergouwen, Mervyn DI; https://orcid.org/0000-0002-6823-1628, Rinkel, Gabriël Je, Roos, Yvo Bwem; https://orcid.org/0000-0001-9205-5882, van den Berg, René, Coert, Bert A, Vandertop, W Peter; https://orcid.org/0000-0001-5417-0265, and Verbaan, Dagmar; https://orcid.org/0000-0002-9212-5470

Abstract

INTRODUCTION: The ULTRA-trial investigated effectiveness of ultra-early administration of tranexamic acid (TXA) in subarachnoid hemorrhage (SAH) and showed that TXA reduces the risk of rebleeding without concurrent improvement in clinical outcome. Previous trials in bleeding conditions, distinct from SAH, have shown that time to start of antifibrinolytic treatment influences outcome. This post-hoc analysis of the ULTRA-trial investigates whether the interval between hemorrhage and start of TXA impacts the effect of TXA on rebleeding and functional outcome following aneurysmal SAH. PATIENTS AND METHODS: A post-hoc comparative analysis was conducted between aneurysmal SAH patients of the ULTRA-trial, receiving TXA and usual care to those receiving usual care only. We assessed confounders, hazard ratio (HR) of rebleeding and odds ratio (OR) of good outcome (modified Rankin Scale 0-3) at 6 months, and investigated the impact of time between hemorrhage and start of TXA on the treatment effect, stratified into time categories (0-3, 3-6 and >6 h). RESULTS: Sixty-four of 394 patients (16.2%) in the TXA group experienced a rebleeding, compared to 83 of 413 patients (19.9%) with usual care only (HR 0.86, 95% confidence interval (CI): 0.62-1.19). Time to start of TXA modifies the effect of TXA on rebleeding rate (p < 0.001), with a clinically non-relevant reduction observed only when TXA was initiated after 6 h (absolute rate reduction 1.4%). Tranexamic acid treatment showed no effect on good outcome (OR 0.96, 95% CI: 0.72-1.27) with no evidence of effect modification on the time to start of TXA (p = 0.53). DISCUSSION AND CONCLUSIONS: This study suggests that the effect of TXA on rebleeding is modified by time to treatment, providing a protective, albeit clinically non-relevant, effect only when started after 6 h. No difference in functional outcome was seen. Routine TXA treatment in the aneurysmal SAH population, even within a specified time frame, is not recommended to impro

Published
2024

8. Ultra-Early and Short-Term Tranexamic Acid Treatment in Patients With Good- and Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Author

Tjerkstra, Maud A; https://orcid.org/0000-0001-9060-3435, Post, René; https://orcid.org/0000-0001-7844-6262, Germans, Menno R; https://orcid.org/0000-0003-2185-4526, Vergouwen, Mervyn D I; https://orcid.org/0000-0002-6823-1628, Jellema, Korne, Koot, Radboud W, Kruyt, Nyika D; https://orcid.org/0000-0002-2320-0932, Wolfs, Jasper F C, De Beer, Frits C; https://orcid.org/0000-0003-4725-7156, Kieft, Hans H; https://orcid.org/0000-0003-2083-710X, Nanda, Dharmin, Van Der Pol, Bram; https://orcid.org/0000-0001-5173-9989, Roks, Gerwin; https://orcid.org/0000-0002-1393-9848, De Beer, Frank, Reichman, Loes J A, Brouwers, Paul J A M, Kwa, Vincent I H; https://orcid.org/0000-0002-0942-6206, Van Der Ree, Taco C, Bienfait, Henri P; https://orcid.org/0000-0002-5698-0031, Boogaarts, Hieronymus D; https://orcid.org/0000-0001-5855-2447, Klijn, Catharina J; https://orcid.org/0000-0002-8495-4578, Visser, Victoria, van den Berg, René, Coert, Bert A, Horn, Janneke; https://orcid.org/0000-0002-3788-7675, Majoie, Charles B L M; https://orcid.org/0000-0002-7600-9568, Rinkel, Gabriël J E, Roos, Yvo B W E M; https://orcid.org/0000-0001-9205-5882, Vandertop, W Peter; https://orcid.org/0000-0001-5417-0265, Verbaan, Dagmar; https://orcid.org/0000-0002-9212-5470, Tjerkstra, Maud A; https://orcid.org/0000-0001-9060-3435, Post, René; https://orcid.org/0000-0001-7844-6262, Germans, Menno R; https://orcid.org/0000-0003-2185-4526, Vergouwen, Mervyn D I; https://orcid.org/0000-0002-6823-1628, Jellema, Korne, Koot, Radboud W, Kruyt, Nyika D; https://orcid.org/0000-0002-2320-0932, Wolfs, Jasper F C, De Beer, Frits C; https://orcid.org/0000-0003-4725-7156, Kieft, Hans H; https://orcid.org/0000-0003-2083-710X, Nanda, Dharmin, Van Der Pol, Bram; https://orcid.org/0000-0001-5173-9989, Roks, Gerwin; https://orcid.org/0000-0002-1393-9848, De Beer, Frank, Reichman, Loes J A, Brouwers, Paul J A M, Kwa, Vincent I H; https://orcid.org/0000-0002-0942-6206, Van Der Ree, Taco C, Bienfait, Henri P; https://orcid.org/0000-0002-5698-0031, Boogaarts, Hieronymus D; https://orcid.org/0000-0001-5855-2447, Klijn, Catharina J; https://orcid.org/0000-0002-8495-4578, Visser, Victoria, van den Berg, René, Coert, Bert A, Horn, Janneke; https://orcid.org/0000-0002-3788-7675, Majoie, Charles B L M; https://orcid.org/0000-0002-7600-9568, Rinkel, Gabriël J E, Roos, Yvo B W E M; https://orcid.org/0000-0001-9205-5882, Vandertop, W Peter; https://orcid.org/0000-0001-5417-0265, and Verbaan, Dagmar; https://orcid.org/0000-0002-9212-5470

Abstract

The results of the ULTRA trial showed that ultra-early and short-term treatment with tranexamic acid (TXA) does not improve clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH). Possibly, the lack of a beneficial effect in all patients with aSAH is masked by antagonistic effects of TXA in certain subgroups. In this post hoc subgroup analysis, we investigated the effect of TXA on clinical outcome in patients with good-grade and poor-grade aSAH.

Published
2024

9. Ultra-Early and Short-Term Tranexamic Acid Treatment in Patients With Good- and Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

Author

Tjerkstra, Maud A., Post, René, Germans, Menno R., Vergouwen, Mervyn D. I., Jellema, Korne, Koot, Radboud W., Kruyt, Nyika D., Wolfs, Jasper F. C., De Beer, Frits C., Kieft, Hans H., Nanda, Dharmin, Van Der Pol, Bram, Roks, Gerwin, De Beer, Frank, Reichman, Loes J. A., Brouwers, Paul J. A. M., Kwa, Vincent I. H., Van Der Ree, Taco C., Bienfait, Henri P., and Boogaarts, Hieronymus D.

Published
2024
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10. Local Control and Toxicity after Stereotactic Radiotherapy in Brain Metastases Patients and the Impact of Novel Systemic Treatments

Author

van Schie, Paul, primary, Huisman, Ruben G., additional, Wiersma, Terry G., additional, Knegjens, Joost L., additional, Navran, Arash, additional, Brandsma, Dieta, additional, Compter, A., additional, Bot, Maarten, additional, Hoogmoed, Jantien, additional, De Witt Hamer, Philip C., additional, Post, René, additional, and Borst, Gerben, additional

Published
2024
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11. Resilience After High-Grade Subarachnoid Hemorrhage: A Prospective Cohort Study on Quality of Life.

Author

Denneman N, Post R, Coert BA, van den Berg R, Verbaan D, and Vandertop WP

Abstract

Background and Objectives: Treatment of patients who present with poor clinical condition is often postponed until neurological improvement is observed. Despite previous studies, it is still unclear how survivors perceive their quality of life (QoL). This study aimed to evaluate self-perceived QoL in patients with aneurysmal subarachnoid hemorrhage who present with poor clinical condition, as defined by World Federation of Neurosurgical Societies (WFNS) grades 4 to 5, compared with those who present in more favorable clinical condition (WFNS 1-3)., Methods: Between 2011 and 2021, 1160 patients with aneurysmal subarachnoid hemorrhage were admitted to the Amsterdam UMC. Among the 845 patients who survived, 537 participated in the QoL questionnaires. Patient characteristics, complications, EQ-5D questionnaires, modified Rankin Scale, and Hospital Anxiety and Depression Scale were analyzed using the nonparametric Mann-Whitney U test for continuous variables or the Pearson χ2 test for categorical variables., Results: Of the 537 responders, 452 (84%) presented with low grade (WFNS 1-3) and 85 (16%) presented with high grade (WFNS 4-5). The high-grade group reported a self-perceived QoL score of 70 (of 100), while the low-grade group reported a score of 75 (P = .12). The mean EQ-5D index value was 0.74 for the high-grade group and 0.81 for the low-grade group (P < .01). In the high-grade group, 61 patients (72%) had a favorable outcome (modified Rankin Scale 0-3) compared with 419 (94%) in the low-grade group (P < .001)., Conclusion: High-grade WFNS patients rated their QoL as satisfactory, with only a marginal 5-point difference on a 100-point scale compared with low-grade WFNS patients. In addition, almost three-quarters of high-grade WFNS survivors achieved a favorable outcome. Given that a subset of patients, despite presenting with a poor clinical condition, still achieve a favorable outcome, these findings reinforce our perspective advocating for early and comprehensive treatment., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Published
2024
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