Ultra-Early Hemostatic Therapy for Intracerebral Hemorrhage

Abstract

Background— Intracerebral hemorrhage (ICH) causes higher morbidity and mortality than other forms of stroke and has no proven effective treatment. Hematoma volume is a powerful predictor of outcome after ICH. Summary of Review— Historically, ICH bleeding was considered to be a monophasic event that stopped quickly as a result of clotting and tamponade by surrounding brain tissue. More recently, prospective and retrospective CT-based studies have demonstrated that hematoma growth occurs in up to 38% of patients initially scanned within 3 hours of onset and in 16% scanned between 3 and 6 hours, even in the absence of coagulopathy. Progressive bleeding of this type has been associated with contrast extravasation on CT angiography and poor outcome after early (<4 hours) surgical clot evacuation. On the basis of these observations, it is plausible that ultra-early hemostatic therapy given in the emergency setting might reduce ICH volume in some patients and improve outcome. Among candidate agents for this indication, the most promising is recombinant activated factor VIIa, which promotes local hemostasis at sites of vascular injury in both coagulopathic and normal patients. Conclusions— Ultra-early hemostatic therapy, given within 3 to 4 hours of onset, may potentially arrest ongoing bleeding and minimize hematoma growth after ICH. Given the current lack of effective therapy for ICH, clinical trials testing this treatment approach are justified.

Spontaneous intracerebral hemorrhage: a review

“…Mayer 79 has proposed using ultra-early hemostatic therapy with recombinant activated factor VII as a potential method of minimizing this early hematoma growth. The author postulated that ultra-early hemostatic therapy for SICH could be used as the counterpart to thrombolytic intervention in cases involving acute ischemic stroke to prevent early neurological deterioration due to hematoma growth and late deterioration related to secondary effects of edema, ischemia, and inflammation.…”

“…5). 79,89 Randomized Trials of Surgical and Medical Management. To date, there are nine prospective randomized controlled studies in which surgical and medical management of SICH has been compared.…”

Relationship between Baseline White Blood Cell and C-Reactive Protein with Mortality in Patients with Spontaneous Intracerebral Hemorrhage

“…sICH is a devastating clinical event without effective therapies despite progressing in medical knowledge [1][2][3][4] with poor outcome [5]. Compared with ischemic stroke and subarachnoid hemorrhage, victims of sICH suffer higher mortality and are left with more severe deficits [3].…”

Therapeutic Strategies in Acute Intracerebral Hemorrhage

“…Seventy three percent of patients express some degree of expansion, and 30 to 40% of patients expand more than 33% from baseline volume [13,18,30,31]. The pathophysiological mechanism by which hematoma expansion occurs remains unclear.…”