Tranexamic Acid with Intensive Blood Pressure Management in Ultra-Early Intracerebral Hemorrhage

Inclusion Criteria:

1. Age between 18 to 80 years old;

2. A definite diagnosis of supratentorial brain parenchymal hemorrhage by non-contrastcranial CT scan;

3. Hemorrhage volume less than 40 mL, as calculated using the ABC/2 method, withultra-early hemorrhage growth (uHG) 10 mL/h or higher;

4. A clear time of symptom onset, and the randomization must occur within 2 hours fromthe onset;

5. At least two measurements of systolic blood pressure that are ≥150 mmHg and <220mmHg, with at least a 2-minute interval between measurements.;

6. Baseline NIHSS of 8 or higher, or unilateral limb muscle strength of 0-3 grades;

7. GCS score greater than 8;

8. The patient or their legal representative has signed an informed consent form.

Exclusion Criteria:

1. Pre-illness mRS > 2;

2. Primary thalamic hemorrhage or intracerebral hemorrhage that has extended into theventricles;

3. Scheduled for surgical intervention (i.e., hematoma evacuation, craniectomy);

4. Secondary ICH from tumors, AVMs, and aneurysms;

5. Traumatic brain injury-related hemorrhage;

6. Recent stroke, TIA, or thrombolytic therapy;

7. On anticoagulants;

8. Blood disorders, platelets <50,000/µL, or INR ≥1.8;

9. Antihypertensive therapy contraindications;

10. Indications for immediate blood pressure reduction;

11. Active thrombosis or thromboembolic history;

12. Hereditary or acquired thrombophilia;

13. Acquired color vision deficiency;

14. Epilepsy history;

15. GFR <90 mL/min;

16. Elevated ALT or liver disease;

17. Allergy to TXA or antifibrinolytics;

18. Life expectancy <12 months;

19. Pregnant or lactating women;

20. In other interventional clinical trials;

21. Other investigator-defined ineligibilities.