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2017 ; 17
(10
): 80
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Management of Spontaneous Intracerebral Hemorrhage
#MMPMID28887767
Veltkamp R
; Purrucker J
Curr Neurol Neurosci Rep
2017[Sep]; 17
(10
): 80
PMID28887767
show ga
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.
|Anticoagulants/*adverse effects/*therapeutic use
[MESH]