Sulfonylurea Use Linked to Better Outcomes in Intracerebral Hemorrhage Patients

Purpose Intracerebral hemorrhage (ICH) accounts for 10‐15% of all strokes and is associated with high morbidity and mortality. While sulfonylureas have shown promise in improving functional outcomes by reducing vasogenic edema via SUR1‐TRPM4 channel inhibition in ischemic stroke, their role in hemorrhagic stroke remains underexplored. We aim to investigate whether prehospital sulfonylurea use is associated with improved clinical and functional outcomes in patients with spontaneous ICH. Methods We will conduct a retrospective cohort study of adult patients (≥18 years) with type 2 diabetes mellitus (T2DM) and acute ICH admitted between July 2020 and March 2025. Patients will be stratified based on sulfonylurea use at the time of admission. Primary outcomes include baseline NIHSS, ICH score and modified Rankin Scale (mRS) at discharge and 3 months. Secondary outcomes include hematoma expansion, in‐hospital mortality, ICU admission, neurosurgical intervention, and hospital length of stay. Exclusion criteria include patients with CNS tumors, vascular abnormalities or coagulopathy. Institutional Review Board (IRB) approval and a HIPAA waiver will be obtained due to the minimal‐risk, retrospective nature of the study. Statistical analyses will include odds ratios and independent t‐tests to assess associations between sulfonylurea use and outcomes, with significance set at p < 0.05. Results We hypothesize that patients already using sulfonylurea on admission will demonstrate lower ICH scores, improved mRS (0‐2) at discharge and 3 months, and reduced secondary complications compared to patients with T2DM not controlled with sulfonylurea. Conclusion Prehospital sulfonylurea use may be associated with better functional and clinical outcomes in patients with ICH. Positive findings could inform future therapeutic strategies involving the use of sulfonylurea in the management of acute hemorrhagic strokes.