Management of spontaneous intracerebral hemorrhage

This paper reviewed the management of spontaneous intracerebral hemorrhage. 

Spontaneous intracerebral hemorrhage refers to a blood clot that arises within the brain. It is spontaneous, meaning that there has been no trauma or surgery. This is associated with a greater risk of death compared to other causes of stroke. Studies show that most patients with small intracerebral hemorrhages survive with good medical care.

The American Heart Association and the American Stroke Association offer guidelines on ways to improve outcomes and reduce the risk of second intracerebral hemorrhages.

Patients taking drugs that prevent blood from clotting (anticoagulants) are more at risk of an intracerebral hemorrhage. Warfarin (Coumadin) is one of the most frequently prescribed oral anticoagulants that prevents blood from clotting. Patients with intracerebral hemorrhage and abnormal blood clotting time because of warfarin should stop warfarin treatment. They should receive therapy to replace vitamin K-dependent factors which were reduced because of warfarin.

Patients with coagulation factor deficiencies (problems with blood clotting) are more at risk of intracerebral hemorrhage. Patients with platelet (type of blood cell) abnormalities are also more at risk of intracerebral hemorrhage. These patients should receive appropriate treatment.

Patients with intracerebral hemorrhage should have intermittent pneumatic compression (therapy to improve circulation).

One study looked at patients who received nicardipine (Cardipine). The study aimed to lower blood pressure within 3 hours of the onset of intracerebral hemorrhage. The best outcomes were seen in the group of patients who achieved the lowest blood pressure. Overall, early intensive blood pressure lowering is safe and feasible.

To prevent intracerebral hemorrhage from happening again in the future, treatment is needed. First, lowering of blood pressure reduces the risk. In one trial, the lowest risk of stroke occurring again was seen among patients with the lowest blood pressure levels on follow-up.

In one study, microbleeds (small bleeding in the brain) were 2.7 times more frequent in patients with intracerebral hemorrhage receiving warfarin than patients who did not use warfarin. However, the optimal time for restarting warfarin therapy after intracerebral hemorrhage is not clear.

The authors concluded that intracerebral hemorrhage is a serious condition where early aggressive care is necessary.