3 research outputs found
Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial
BackgroundTranexamic acid (TXA) reduces death due to bleeding after trauma and post-partum haemorrhage. The aim was to assess if tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral 6 haemorrhage (ICH). MethodsWe undertook an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage. Participants received 1g intravenous tranexamic acid bolus followed by an 8 hour 1g infusion, or matching placebo, within 8 hours of symptom onset. The primary outcome was functional status at day 90, measured by shift in the modified Rankin Scale (mRS), using ordinal logistic regression, with adjustment for stratification and minimisation criteria. All analyses were performed on an intention to treat basis. This trial is registered as ISRCTN93732214.FindingsWe recruited 2,325 participants (TXA 1161, placebo 1164) from 124 hospitals in 12 countries between 2013 and 2017. Treatment groups were well balanced at baseline. The primary outcome was determined for 2307 (99路2%) participants. There was no statistically significant difference between the groups for the primary outcome of functional status at day 90 (adjusted odds ratio [aOR] 0路88, 95% CI 0路76-1路03, p=0路11). Although there were fewer deaths by day 7 in the TXA group (aOR 0路73, 95% CI 0路53-0路99, p=0路0406), there was no difference in case fatality at 90 days (adjusted hazard ratio 0路92, 95% CI 0路77 to 1路10, p =0路37). There were fewer serious adverse events after TXA vs. placebo by days 2 (p=0路0272), 7 (p=0路0200) and 90 (p=0路0393).InterpretationThere was no significant difference in functional status 90 days after intracerebral haemorrhage with tranexamic acid, despite a reduction in early deaths and serious adverse events. Larger randomised trials are needed to confirm or refute a clinically significant treatment effect
Individualised cost-effectiveness analysis in risk-based screening: practical and ethical?
<p>Slides presented at Personalised Medicine and Resource Allocation conference at University of Oxford on 2nd March 2015.</p
The relationship between individual risk and cost-effectiveness in screening interventions
<p>Working paper describing the relationship between individual risk and the cost-effectiveness of screening. Suggests a means of optimising the cost-effectiveness of risk-based screening programmes.</p