PURPOSE: Haematoma expansion is a devastating complication of intracerebral 
haemorrhage (ICH) with no established treatment. Tranexamic acid had been an 
effective haemostatic agent in reducing post-operative and traumatic bleeding. 
We review current evidence examining the efficacy of tranexamic acid in 
improving clinical outcome after ICH.
METHOD: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for 
studies using search strategies incorporating the terms 'intracerebral 
haemorrhage', 'tranexamic acid' and 'antifibrinolytic'. Authors of ongoing 
clinical trials were contacted for further details.
FINDINGS: We screened 268 publications and retrieved 17 articles after 
screening. Unpublished information from three ongoing clinical trials was 
obtained. We found five completed studies. Of these, two randomised controlled 
trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported 
no significant difference in death or dependency. Three observational studies 
(n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. 
There are six ongoing RCTs (n = 3089) with different clinical exclusions, 
imaging selection criteria (spot sign and haematoma volume), time window for 
recruitment and dosing of tranexamic acid.
DISCUSSION: Despite their heterogeneity, the ongoing trials will provide key 
evidence on the effects of tranexamic acid on ICH. There are uncertainties of 
whether patients with negative spot sign, large haematoma, intraventricular 
haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for 
optimal effect of haemostatic therapy in ICH is yet to be established.
CONCLUSION: Tranexamic acid is a promising haemostatic agent for ICH. We await 
the results of the trials before definite conclusions can be drawn.