The first scientifically proven treatments for intracerebral hemorrhage are on the horizon, including a new drug that holds promise for slowing bleeding and limiting brain damage resulting from such a stroke, according to updated American Heart Association/American Stroke Association guidelines.
The guidelines, published in the journal Stroke, also address the feasibility and timing of surgical options and different ways to take pictures of the brain to diagnose a hemorrhagic stroke, as well as offer guidance on end-of-life issues such as putting do-not-resuscitate orders on hold for a full day after such a stroke occurs.
Reducing high blood pressure is still the best way to avoid ICH, said Joseph Broderick, MD, the chairman of the guideline committee and a professor and the chairman of neurology at the University of Cincinnati.
When the AHA/ASA published guidelines for managing ICH in 1999, researchers had conducted only five small, randomized medical studies and four small, randomized surgical trials for acute ICH. In the past six years, 15 pilot and larger randomized medical and surgical trials for ICH/intraventricular hemorrhage (IVH) have been completed or are ongoing.
Since the last Guidelines for Management of ICH were published, researchers completed the largest ever surgical trial of intracerebral hemorrhage, Dr. Broderick said. Surgery is recommended as a potentially life-saving procedure for patients with a larger ICH in the cerebellum that presses upon the brainstem. Minimally invasive ways to remove blood clots are under investigation.
The guidelines also recommend that ICH patients be managed in an ICU, that they be given recombinant activated factor VII (rFVIIa) within four hours of onset, that blood pressure be managed acutely, and that physicians identify the ICH using computed tomography or magnetic resonance imaging, which were judged equally effective in the guidelines.