Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies

Song, Lili; Sandset, Else Charlotte; Arima, Hisatomi; Heeley, Emma; Delcourt, Candice; Chen, Guofeng; Yang, Jie; Wu, Guojun; Wang, Xia; Lavados, Pablo M.; Huang, Yining; Stapf, Christian; Wang, Ji‐Guang; Robinson, Thompson; Chalmers, John; Lindley, Richard I.; Anderson, Craig S.

doi:10.1136/jnnp-2016-313246

Cited by 16 publications

(10 citation statements)

References 29 publications

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“…In addition, as not all ICH patients can benefit from intensive SBP lowering, it is necessary to select subgroups of patients at high risk of developing HE. Actually, studies have shown that those ICH patients who presents with an early onset, higher initial SBP, prior anti-thrombotic therapy, or milder neurological dysfunction at baseline were found to be associated with better functional outcomes in rapid SBP lowering (114,125,126). However, currently the characteristics of ICH patients benefiting from SBP control are still unclear and a complete screening scheme should be established to facilitate clinical practice in future studies.…”

Section: Intensive Blood Pressure-lowering Treatmentmentioning

confidence: 99%

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

You

Long

et al. 2020

Front. Neurol.

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Intracerebral hemorrhage (ICH) is the most lethal type of stroke, but there is no specific treatment. After years of effort, neurologists have found that hematoma expansion (HE) is a vital predictor of poor prognosis in ICH patients, with a not uncommon incidence ranging widely from 13 to 38%. Herein, the progress of studies on HE after ICH in recent years is updated, and the topics of definition, prevalence, risk factors, prediction score models, mechanisms, treatment, and prospects of HE are covered in this review. The risk factors and prediction score models, including clinical, imaging, and laboratory characteristics, are elaborated in detail, but limited by sensitivity, specificity, and inconvenience to clinical practice. The management of HE is also discussed from bench work to bed practice. However, the upmost problem at present is that there is no treatment for HE proven to definitely improve clinical outcomes. Further studies are needed to identify more accurate predictors and effective treatment to reduce HE.

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Section: Intensive Blood Pressure-lowering Treatmentmentioning

confidence: 99%

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

You

Long

et al. 2020

Front. Neurol.

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“…None of these trials have shown a significant improvement in outcome although there is evidence of reduced hematoma expansion. The Factor VIIa in Acute Intracerebral Hemorrhage (FAST) trial showed reduced hematoma expansion over the first 24 hours 45 and a secondary analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2) found that blood pressure reduction reduced ICH plus IVH hematoma expansion 46 .…”

Section: Preventionmentioning

confidence: 99%

Challenges for intraventricular hemorrhage research and emerging therapeutic targets

Garton

Hua

Xiang

et al. 2017

Expert Opinion on Therapeutic Targets

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Introduction – Intraventricular hemorrhage (IVH) affects both premature infants and adults. In both demographics, it has high mortality and morbidity. There is no FDA approved therapy that improves neurological outcome in either population highlighting the need for additional focus on therapeutic targets and treatments emerging from preclinical studies. Areas Covered – IVH induces both initial injury linked to the physical effects of the blood (mass effect) and secondary injury linked to the brain response to the hemorrhage. Preclinical studies have identified multiple secondary injury mechanisms following IVH, and particularly the role of blood components (e.g. hemoglobin, iron, thrombin). This review, with an emphasis on pre-clinical IVH research, highlights therapeutic targets and treatments that may be of use in prevention, acute care, or repair of damage. Expert Opinion – An IVH is a potentially devastating event. Progress has been made in elucidating injury mechanisms, but this has still to translate to the clinic. Some pathways involved in injury also have beneficial effects (coagulation cascade/inflammation). A greater understanding of the downstream pathways involved in those pathways may allow therapeutic development. Iron chelation (deferoxamine) is in clinical trial for intracerebral hemorrhage and preclinical data suggest it may be a potential treatment for IVH.

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“…Based on available evidence, rapidly reducing blood pressure to 140-150 mmHg may likely balance the risk of hemorrhage expansion and cerebral autoregulation issues, although patients with higher presenting blood pressure (i.e. ≥ 180 mmHg) may have a greater risk of renal injury [30][31][32][33][34][35]. Knowledge of the patient's pre-ICH baseline blood pressures readings as well as frequent neurological assessments during hospitalization may help guide antihypertensive therapy and avoid further complications in the acute setting.…”

Section: Blood Pressure Managementmentioning

confidence: 99%

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Sandler¹,

Almohaish²,

Brophy³

2021

OBM Geriatrics

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Pharmacological management of intracerebral hemorrhage in adult patients over 65 years of age requires special considerations due to differing clinical presentations, underlying organ dysfunction, and more complex medical histories and medication profiles. A literature review of articles focusing on the age-specific pharmacological management of intracerebral hemorrhage was conducted. Treatment approaches and clinical outcomes specific to older adults were evaluated and therapeutic considerations for this population are summarized. Older adults were commonly included in trials regarding reversal of anticoagulants and antiplatelet agents and these results are generalizable to older adults. Underlying organ dysfunction should frequently be considered throughout the treatment of intracerebral hemorrhage in older adults. Older adults with intracerebral hemorrhage should be managed similarly to younger adult patients; however, consideration of age-related comorbidities and physiological differences is critically important for optimizing patient care.

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Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies

Abstract: NCT00226096, NCT00716079.

Cited by 16 publications

References 29 publications

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

Challenges for intraventricular hemorrhage research and emerging therapeutic targets

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

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