Treatment for intracerebral hemorrhage: Dawn of a new era
- PMID: 38803115
- DOI: 10.1177/17474930241250259
Treatment for intracerebral hemorrhage: Dawn of a new era
Abstract
Intracerebral hemorrhage (ICH) is a devastating disease, causing high rates of death, disability, and suffering across the world. For decades, its treatment has been shrouded by the lack of reliable evidence, and consequently, the presumption that an effective treatment is unlikely to be found. Neutral results arising from several major randomized controlled trials had established a negative spirit within and outside the stroke community. Frustration among researchers and a sense of nihilism in clinicians has created the general perception that patients presenting with ICH have a poor prognosis irrespective of them receiving any form of active management. All this changed in 2023 with the positive results on the primary outcome in randomized controlled trials showing treatment benefits for a hyperacute care bundle approach (INTERACT3), early minimal invasive hematoma evacuation (ENRICH), and use of factor Xa-inhibitor anticoagulation reversal with andexanet alfa (ANNEXa-I). These advances have now been extended in 2024 by confirmation that intensive blood pressure lowering initiated within the first few hours of the onset of symptoms can substantially improve outcome in ICH (INTERACT4) and that decompressive hemicraniectomy is a viable treatment strategy in patients with large deep ICH (SWITCH). This evidence will spearhead a change in the perception of ICH, to revolutionize the care of these patients to ultimately improve their outcomes. We review these and other recent developments in the hyperacute management of ICH. We summarize the results of randomized controlled trials and discuss related original research papers published in this issue of the International Journal of Stroke. These exciting advances demonstrate how we are now at the dawn of a new, exciting, and brighter era of ICH management.
Keywords: Intracerebral hemorrhage; andexanet alfa; anticoagulation reversal; blood pressure control; care bundle; direct oral anticoagulants; hematoma evacuation; minimal invasive surgery.
Conflict of interest statement
Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: D.J.S. received funding from the Swiss National Science Foundation, the Swiss Heart Foundation, the Bangerter-Rhyner foundation, and AstraZeneca. D.J.S. received fees (paid to his institution) for speaker bureau and consultancy from AstraZeneca, VamX, Bioxodes, Javelin, and Pfizer. C.S.A. reports receiving research grants from the National Health and Medical Research Council of Australia, the Medical Research Council and Medical Research Foundation of the UK, and Penumbra and Takeda, paid to his institution.
