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Review
. 2017 Sep 8;17(10):80.
doi: 10.1007/s11910-017-0783-5.

Management of Spontaneous Intracerebral Hemorrhage

Roland Veltkamp  1   2 , Jan Purrucker  3
Affiliations
Review

Management of Spontaneous Intracerebral Hemorrhage

Roland Veltkamp et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: We review the current evidence for medical and surgical treatments of spontaneous intracerebral hemorrhage (ICH).

Recent findings: Therapy with hemostatic agents (e.g. factor VIIa and tranexamic acid) if started early after bleeding onset may reduce hematoma expansion, but their clinical effectiveness has not been shown. Rapid anticoagulation reversal with prothrombin concentrates (PCC) plus vitamin K is the first choice in vitamin K antagonist-related ICH. In ICH related to dabigatran, anticoagulation can be rapidly reversed with idarucizumab. PCC are recommended for ICH related to FXa inhibitors, whereas specific reversal agents are not yet approved. While awaiting ongoing trials studying minimally invasive approaches or hemicraniectomy, the role of surgery in ICH remains to be defined. Therapies targeting downstream molecular cascades in order to prevent secondary neuronal damage are promising, but the complexity and multi-phased nature of ICH pathophysiology is challenging. Finally, in addition to blood pressure control, antithrombotic prevention after ICH has to consider the risk of recurrent bleeding as well as the risk of ischemic events. Treatment of acute ICH remains challenging, and many promising interventions for acute ICH await further evidence from trials.

Keywords: Anticoagulation; Antihypertensive; Hematoma growth; Hemostatic therapy.

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Conflict of interest statement

Conflict of Interest

Roland Veltkamp reports grants from the Boehringer Ingelheim, Bayer, BMS, Daiichi Sankyo, and Biogen. Dr. Veltkamp reports personal fees from the PHRI-Portola, Boehringer Ingelheim, Bayer, BMS, Daiichi Sankyo, and Biogen.

Jan Purrucker reports personal fees from Pfizer and Boehringer Ingelheim.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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