Focused Update on Vascular Risk and Secondary Prevention in Survivors of Intracerebral Hemorrhage

Sheth, Kevin N; Selim, Magdy

doi:10.1161/strokeaha.122.039819

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…Many of the risk factors leading to the index ICH indeed persist and increase the risk of recurrent events. 17 Age, Asian or Black race and presence of the APOE ε2 or ε4 alleles are the main nonmodifiable risk factors increasing the odds of recurrent ICH. Conversely, elevated blood pressure is the main modifiable determinant of ICH recurrence and the most appealing therapeutic target.…”

Section: Clinical Predictorsmentioning

confidence: 99%

“…The clinical history of ICH survivors is traditionally challenged by risk of recurrence. Many of the risk factors leading to the index ICH indeed persist and increase the risk of recurrent events 17 . Age, Asian or Black race and presence of the APOE ε2 or ε4 alleles are the main non‐modifiable risk factors increasing the odds of recurrent ICH.…”

Section: Stratification Of Ischaemic and Haemorrhagic Riskmentioning

confidence: 99%

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Secondary prevention after intracerebral haemorrhage

Toffali

Carbone

Fainardi

et al. 2023

Eur J Clin Investigation

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Background Intracerebral haemorrhage (ICH) has high mortality in the acute phase and poor functional outcome in the majority of survivors. ICH recurrence is a major determinant of long‐term prognosis and is the most feared complication of antithrombotic treatment. On the other hand, ICH patients are at high risk of future ischaemic vascular events. Methods This narrative review provides a critical analysis of the current knowledge on the topic. We performed a Pubmed search with the following terms ‘intracerebral haemorrhage’, ‘stroke’, ‘outcome’, ‘secondary prevention’, ‘anticoagulation’ and ‘atrial fibrillation’, including only English written studies with no time restrictions. Results Blood pressure management is the cornerstone of secondary ICH prevention, regardless of ICH location or underlying cerebral small vessel disease. Resumption of antiplatelet and anticoagulation therapy is often challenging, with limited evidence from randomized trials. Clinical and imaging predictors can inform the stratification of ICH recurrence risk and might identify patients at very high probability of future haemorrhagic events. This narrative review provides a summary of the main diagnostic tools and therapeutic strategies available for secondary prevention in ICH survivors. Conclusion Appropriate recognition and treatment of modifiable risk factors for ICH recurrence might improve outcomes in ICH survivors. Ongoing randomized trials might provide novel insights and improve long‐term management.

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Section: Clinical Predictorsmentioning

confidence: 99%

Section: Stratification Of Ischaemic and Haemorrhagic Riskmentioning

confidence: 99%

Secondary prevention after intracerebral haemorrhage

Toffali

Carbone

Fainardi

et al. 2023

Eur J Clin Investigation

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“…However, this principle is simpler in theory than in practice as patients with ICH often necessitate ischemic vascular preventative treatments that could increase the risk of ICH recurrence, such as antithrombotic and lipid-lowering therapies, for competing comorbid ischemic vaso-occlusive or thromboembolic diseases. [1][2][3] To complicate matters further, it is becoming increasingly apparent that patients with ICH are at a heightened risk of major thrombotic vascular events, particularly over the first months following ICH. 4 Accordingly, whether ICH survivors with competing ischemic vascular diseases should resume ischemic vascular preventative treatments and, if yes, the optimal timing of their resumption are active areas of controversy and investigation.…”

Section: Timing Of Antiplatelet Resumption Aftermentioning

confidence: 99%

Timing of Antiplatelet Resumption After Intracerebral Hemorrhage: A Sophie’s Choice

Katsanos

Shoamanesh

2023

Stroke

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“…1 ICH survivors have moderate to severe disability and cognitive decline, requiring assistance in daily activities. 2 However, few efficient drugs have been developed to improve the neurofunctional outcomes of ICH. 3 Therefore, exploring the pathological mechanisms of ICH and seeking effective treatments are urgently needed.…”

mentioning

confidence: 99%

Oxytocin Improves Intracerebral Hemorrhage Outcomes by Suppressing Neuronal Pyroptosis and Mitochondrial Fission

Yang

Deng

Jiang

et al. 2023

Stroke

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Background: Intracerebral hemorrhage (ICH) causes severe sensorimotor dysfunction and cognitive decline which are aggravated by secondary brain injury, yet there are no effective management to alleviate these outcomes. Pyroptosis is strongly related to neuroinflammation, which plays a crucial role in the pathophysiological processes of secondary brain injury after ICH. OXT (oxytocin), as a pleiotropic neuropeptide, has multiple functions including anti-inflammation and antioxidation. This study aims to investigate the role of OXT in improving ICH outcomes and the underlying mechanisms. Methods: C57BL/6 mice were used to establish the ICH model by autologous blood injection. OXT was administered intranasally (0.2 μg/g) after ICH. Combing behavioral tests, Western blot, immunofluorescence staining, electron microscopy, and pharmacological approaches, we evaluated the effect of intranasal OXT application on neurological outcomes after ICH and explored the underlying mechanism. Results: Endogenous OXT level was decreased, whereas OXTR (oxytocin receptor) expression was increased after ICH. OXT treatment improved the short-term and long-term neurological functions and alleviated neuronal pyroptosis and neuroinflammation. In addition, OXT reduced excessive mitochondrial fission and mitochondrial-derived oxidative stress 3 days after ICH. OXT decreased the expression of pyroptotic and proinflammatory factors including NLRP3 (NOD-like receptor protein 3), ASC (apoptosis-associated speck-like protein containing a CARD), GSDMD (gasdermin D), caspase-1, IL (interleukin)-1β, and IL-18 and increased the expression of p-PKA (phospho-protein kinase A) and p-DRP1 (S637; DRP1 [dynamin-related protein 1] phosphorylation at Ser637). OXT-induced neuroprotective effects were blocked by either OXTR inhibitor or PKA inhibitor. Conclusions: Intranasal application of OXT can ameliorate neurological deficits and alleviate neural pyroptosis, inflammation, and excessive mitochondrial fission via OXTR/p-PKA/DRP1 signaling pathway after ICH. Thus, OXT administration may be a potential therapeutic strategy to improve the prognosis of ICH.

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Focused Update on Vascular Risk and Secondary Prevention in Survivors of Intracerebral Hemorrhage

Cited by 9 publications

References 8 publications

Secondary prevention after intracerebral haemorrhage

Secondary prevention after intracerebral haemorrhage

Timing of Antiplatelet Resumption After Intracerebral Hemorrhage: A Sophie’s Choice

Oxytocin Improves Intracerebral Hemorrhage Outcomes by Suppressing Neuronal Pyroptosis and Mitochondrial Fission

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