ABSTRACT NUMBER: ESOC2026A912 THROMBOTIC EVENTS, HAEMATOMA EXPANSION AND FUNTIONAL OUTCOME: A SECONDARY ANALYSIS OF THE TICH-2 RANDOMIZED CONTROLLED TRIAL

Abstract Background and aims Background: Hemostatic therapy for intracerebral hemorrhage (ICH) reduces haematoma expansion (HE) but increases thromboembolic events (TE). We compared their rates and clinical outcomes. Methods The TICH-2 trial assessed tranexamic acid in patients with acute sporadic ICH. In a post hoc analysis, we assessed the association between HE (absolute ≥6 mL, relative ≥33%) and TE (ischemic stroke = IS, myocardial infarction = MI, pulmonary embolism = PE, deep vein thrombosis = DVT) with mortality and good functional outcome (modified Rankin scale score 0-2) at 90 days using multivariable models calculating adjusted odds (aOR) and hazard ratios (aHR) with 95% confidence intervals (95%CI). Results Of all 2325 TICH-2 participants 570 (27,4%) had HE and 111 (4,7%) had TE (23 IS, 17 MI, 43 PE, 33 DVT); 499 (21,6%) died and 667 (28,9%) had good functional outcome. History of atrial fibrillation (aHR 2.50, 95%CI 1.06-5.88, P = 0.036) but not HE was associated with occurrence of TE. Both, HE (aHR 2.07, 95%CI 1.67-2.56, P < 0.001) and TE (aHR 1.65, 95%CI 1.09-2.51, P = 0.019) were independently associated with mortality. Both, HE (aOR 0.45, 95%CI 0.33-0.62, P < 0.001) and TE (aOR 0.41, 95%CI 0.21-0.80, P = 0.009) were independently associated with reduced good functional outcome. Assessing TE types separately, only MI (aHR 2.68, 95%CI 1.29-5.55, P = 0.008) was associated with mortality and only PE (aOR 0.13, 95%CI 0.03-0.58, P = 0.008) with reduced good functional outcome. Conclusions Occurrence of HE is 5-fold more frequent than TE in patients with ICH. Both are independently associated with increased mortality and reduced odds for good functional outcome. Conflict of interest Nothing to disclose.