Key result
Rapid anticoagulation reversal and blood pressure control limit hematoma expansion in intracerebral hemorrhage.
Why the study?
Intracerebral haemorrhage is a highly fatal stroke subtype with limited treatment options and has been largely neglected in clinical trials until recently.
Intracerebral haemorrhage is a highly lethal medical emergency that requires prompt intervention, such as rapid reversal of oral anticoagulants, which is currently underutilized in clinical practice.
Emphasizes time-critical ICH protocols; Level 5 evidence leaves open optimal reversal strategies for prospective validation.
Intracerebral haemorrhage (ICH) is the deadliest form of stroke, carrying a mortality rate between 30% and 55%, increasing to 67% in patients on oral anticoagulant therapy (OAT). Despite its relevant incidence, the treatment of ICH has been until recently a largely neglected item, addressed by only a few trials. Early treatment of ICH in non-anticoagulated patients with recombinant activated factor VII (rFVII) has been demonstrated to be able to limit the growth of the haematoma, but such a promising result requires further confirmations. In ICH patients receiving OAT a prompt reversal of the anticoagulant effect should be warranted in order to reduce the consequences of this dreadful adverse event. In clinical practice, however, just a small proportion of anticoagulated patients receive this treatment, probably because of the fear of thromboembolic complications. It is now time to check our way of thinking about ICH, regarding and treating it as a compelling medical emergency.
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Marietta et al. (2007) conducted a review in Intracerebral haemorrhage. Emergency medical management and hemostatic therapy was evaluated. Intracerebral hemorrhage is a compelling medical emergency requiring rapid blood pressure control and immediate reversal of anticoagulation to limit hematoma expansion and reduce high mortality rates.