Advances in Therapeutic Approaches for Spontaneous Intracerebral Hemorrhage

Neurotherapeutics. 2020 Oct;17(4):1757-1767. doi: 10.1007/s13311-020-00902-w.

Abstract

Spontaneous intracerebral hemorrhage (ICH) results in high rates of morbidity and mortality, with intraventricular hemorrhage (IVH) being associated with even worse outcomes. Therapeutic interventions in acute ICH have continued to emerge with focus on arresting hemorrhage expansion, clot volume reduction of both intraventricular and parenchymal hematomas, and targeting perihematomal edema and inflammation. Large randomized controlled trials addressing the effectiveness of rapid blood pressure lowering, hemostatic therapy with platelet transfusion, and other clotting complexes and hematoma volume reduction using minimally invasive techniques have impacted clinical guidelines. We review the recent evolution in the management of acute spontaneous ICH, discussing which interventions have been shown to be safe and which may potentially improve outcomes.

Keywords: Fibrinolysis; Intracerebral hemorrhage; Intraventricular hemorrhage; Outcomes; Stroke.

Publication types

  • Review

MeSH terms

  • Antifibrinolytic Agents / pharmacology
  • Antifibrinolytic Agents / therapeutic use
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / drug therapy*
  • Cerebral Hemorrhage / surgery*
  • Hemostasis / drug effects
  • Hemostasis / physiology
  • Humans
  • Minimally Invasive Surgical Procedures / methods*

Substances

  • Antifibrinolytic Agents
  • Antihypertensive Agents