Guideline Updated for Management of Spontaneous ICH
Some in-hospital therapies and prophylactic treatments may confer no benefit or are potentially harmful and should be reconsidered
TUESDAY, May 17, 2022 (HealthDay News) -- In an updated guideline issued by the American Heart Association/American Stroke Association and published online May 17 in Stroke, recommendations are presented for the management of intracerebral hemorrhages (ICHs).
Steven M. Greenberg, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues developed evidence-based guidelines for ICH, which accounts for about 10 percent of the 795,000 strokes per year in the United States.
The authors note that organization of health care systems is a key component of optimal stroke care. Regional systems that provide initial ICH care should be developed, with the capacity for rapid transfer to facilities with neurocritical care and neurosurgical capabilities when necessary. Hematoma expansion is associated with worse ICH outcome; neuroimaging markers and clinical markers can help predict the risk for hematoma expansion. Treatment regimens for lowering blood pressure after acute ICH that limit blood pressure variability and achieve sustained blood pressure control seem to reduce hematoma expansion and yield better outcomes. Extremely high mortality and morbidity are seen for ICH while anticoagulated; updated recommendations are provided for acute reversal of anticoagulation after ICH. Several in-hospital therapies that have been used to treat ICH may either confer no benefit or even harm; for example, prophylactic corticosteroids or continuous hyperosmolar therapy for emergency or critical care treatment of ICH appear to have no benefit for outcome.
"There is no easy path to preventing or curing bleeding strokes, yet there is encouraging progress across all aspects of this disease, from prevention to in-hospital treatment and posthospital recovery," Greenberg said in a statement.
Several authors and reviewers disclosed ties to the pharmaceutical industry; one author holds a patent.