Mitchell S.V. Elkind, M.D., is American Heart Association president-elect, chair of the Advisory Committee of the American Stroke Association — a division of the American Heart Association and professor of neurology and epidemiology at Columbia University New York. 

copyright American Heart Association

"Tranexamic acid is one of a group of drugs that are hemostatic agents, that help to stop blood from bleeding. They help to cause coagulation, promote coagulation. And yes, we have other agents that have done this in the past. Activated factor VII, for example, is one that was tested in a few large-scale trials. And again, there was some evidence that agents like this can prevent hematoma growth. And yet, they didn't necessarily show evidence of clinical benefit.

And I think, again, that's because once the bleeding occurs, we have very little time to have an impact. This trial, the STOP-AUST study, does suggest that as well because we see a benefit in those patients treated ultra early, within just a couple of hours.

And the benefits wear off after that. With ischemic stroke, we have a four-and-a-half-hour window now or a six-hour for endovascular therapy, perhaps even up to 24 hours in selective patients. So here, again, selecting the right patients and having a very short time window, we may be able to make a difference. A generalizability, perhaps, is going to be an issue."