Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020

Abstract

Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke. Prior to this edition, intracerebral hemorrhage was included in the Acute Stroke Management module and was limited to its management during the first 12 h. With the growing evidence on intracerebral hemorrhage, a separate module focused on this topic across the care continuum was added. In addition to topics related to initial clinical management, neuroimaging, blood pressure management, and surgical management, new sections have been introduced addressing topics surrounding inpatient complications such as venous thromboembolism, seizure management, and increased intracranial pressure, rehabilitation as well as issues related to secondary management including lifestyle management, maintaining a normal blood pressure and antithrombotic therapy, are addressed. The Canadian Stroke Best Practice Recommendations ( CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke and to promote optimal recovery and reintegration for people who have experienced stroke, including patients, families, and informal caregivers.

Central Nervous System Tissue Regeneration after Intracerebral Hemorrhage: The Next Frontier

“…Rehabilitation has been widely used for decades to improve patients' functional recovery after ICH and shown stable efficacy [223,224]. Growing evidence from clinical trials and a cohort study suggest that rehabilitation should be implemented as early as possible and continue for a more extended period [225][226][227][228].…”

Management of Coagulopathy in Bleeding Patients

“…Furthermore, in emergency situations the administration of specific reversal agents can be delayed if the type and plasma level of DOAC present in a patient’s blood needs to be rapidly identified with specific tests [ 58 , 59 ]. Non-specific strategies for the treatment of DOAC-associated bleeding, such as administration of PCC, are now widely recognised and recommended by different organisations for situations when specific agents are not readily available [ 12 , 14 , 41 , 42 , 47 , 48 , 50 , 51 , 52 , 54 , 60 ]. The guideline recommendations are summarised in Table 1 .…”

Stroke in Patients with Left Ventricular Assist Devices

“…Attention to rapidly available coagulation parameters allows decision making around anticoagulation reversal with prothrombin complex concentrate and IV vitamin K for those patients on warfarin, or IV protamine for those on heparin. Optimal blood pressure control with systolic blood pressure definitely <180 mm Hg and perhaps with a maximum target of 140–160 mm Hg (or a MAP target of <110 mm Hg) for the first 24–48 h [66, 67] is suggested through both conservative (treatment of pain, urinary retention, etc.) and medical (IV blood pressure medications) interventions.…”