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-contrast cranial CT scan; 3. Hemorrhage volume less than 40 mL, as calculated using the ABC/2 method, with ultra-early hemorrhage growth (uHG) 10 mL/h or higher; 4. A clear time of symptom onset, and the randomization must occur within 2 hours from the onset; 5. At least two measurements of systolic blood pressure that are ≥150 mmHg and \<220 mmHg, 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 the ventricles; 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.