Abstract Background and aims Spontaneous intracerebral haemorrhage (ICH) is the most severe form of stroke. Previous trials have largely failed to improve functional outcomes. The INTERACT 3 trial demonstrated that implementing a care bundle protocol (CBP) focused on intensive blood pressure (BP) lowering and early physiological management can improve outcomes. We aimed to evaluate acute management and outcomes of CBP implementation in routine clinical practice. Methods This interim analysis of an ongoing, prospectively collected observational study used data from the international SITS-ICH Registry. Baseline characteristics, imaging data, acute management, and 3-month outcomes were recorded. Patients were classified as treated according to CBP or standard care (SC). Descriptive and multivariable mixed effects regression analyses were performed to adjust for baseline imbalances. Results Between January 2024 and October 2025, 1,989 patients from 58 centres across 23 countries were included. Median age was 69 years and median NIHSS score 9. CBP-treated patients had smaller ICH volumes (15 vs. 20 mL), higher baseline NIHSS (10 vs. 6), BP, glucose, and temperature, OAC use (17.5% vs. 12.1%), and received more haemostatic (27% vs. 7%) and surgical interventions (7% vs. 1%) compared with SC. Mortality (44% vs. 57%) and median modified Rankin Scale (mRS) scores (5 vs. 6) were lower in CBP-treated patients, but adjusted analyses showed no significant differences (death OR 0.81 0.26–2.5; ordinal mRS OR 0.86 0.37–2.0). In this interim analysis, CBP-treated patients had higher cardiovascular risk, with no significant adjusted 3-month outcome differences versus SC, although missing data and follow-up loss may have influenced results. Conflict of interest Marius Matusevicius: Nothing to disclose. Anand Dixit: Nothing to disclose. Jose Egido: Nothing to disclose. Daniel Strbian: Nothing to disclose. Sabrina Anticoli: Nothing to disclose. Niaz Ahmed: Nothing to disclose.
Matusevicius et al. (Fri,) studied this question.