Limited data are available on the prevention of intracerebral hemorrhage (ICH) recurrence, which is substantial, especially in the case of lobar ICH related to cerebral amyloid angiopathy. In view of the relative paucity of prospectively generated data, current strategies for the secondary prevention of ICH involve the extrapolation of data on primary prevention of ICH to its secondary prevention and the avoidance of certain agents that have been shown in clinical series to be associated with increased risk of ICH recurrence. This review analyzes ways to approach the secondary prevention of ICH in the setting of a paucity of adequate prospectively generated data on the subject.
Risk factors for ICH recurrence identified through data extrapolation include hypertension, diabetes, excessive alcohol consumption, cigarette smoking, and probably migraine with aura. Agents associated with increased risk of ICH recurrence include warfarin, antiplatelet agents, statins, and vitamin E.
This article reviews the prevention of ICH recurrence based on extrapolating data from primary prevention of ICH along with the clinically appropriate strategy of avoiding the use of agents that have been shown to carry an increased risk of ICH recurrence.
Address correspondence to Dr Carlos S. Kase, Department of Neurology, Boston University School of Medicine, 715 Albany St # C-329, Boston, MA 02118, firstname.lastname@example.org.
Relationship Disclosure: Dr Kase has received research support from the NIH and personal compensation as an expert witness. Dr Kurth has received personal compensation for activities from MAP Pharmaceuticals, Inc., Merck & Co., Inc., and the American Academy of Neurology and has received personal compensation for editorial activities from BMJ. Dr Kurth has received research support from the French National Research Agency, the US National Institutes of Health, Merck, the Migraine Research Foundation, and the Parkinson's Research Foundation.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Kase and Kurth report no disclosure.