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(Stroke. 2009;40:1539.)
© 2009 American Heart Association, Inc.

Emerging Therapies

Intracerebral Hemorrhage

What’s Next?

From Department of Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wis.

Correspondence to Michel T. Torbey, MD, MPH, FAHA, FCCM, Director, Stroke Critical Care Program, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226. E-mail mtorbey@mcw.edu

Marc Fisher MD Kennedy Lees MD Section Editors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A proven and effective treatment for intracerebral hemorrhage (ICH) remains an elusive goal. Results of recent clinical trials have been bitterly disappointing. Neither a surgical approach focusing on evacuation of the hematoma¹ nor a medical approach focusing on neuroprotective strategies^2,3 have shown any clinically relevant benefit.

The hematoma in ICH is a dynamic expanding mass. An increase in hematoma volume of >33% is seen in 38% of patients scanned within 3 hours of symptoms onset.⁴ In two-thirds of patients this increase in volume is seen within 1 hour.⁴ Because volume of the hematoma has been shown to be an important predictor of mortality and functional outcome,⁵ an approach focusing on preventing further bleeding is worth investigating.

In a recent phase 2 trial, a role for ultra-early hemostatic therapy with recombinant activated factor VII (rFVIIa) was identified.⁶ In this study, 399 patients with ICH were randomly assigned to receive placebo or 40, 80, or 160 µg of rFVIIa per kg of body weight. Treatment was given within 1 hour of the baseline CT scan and no later than 4 hours of symptoms onset. The primary efficacy endpoint for the study was the percent change in the volume of ICH. Global outcomes at 90 days were assessed using modified Rankin scale and the extended Glasgow Outcome scale. Of note, death and complete dependence on others was defined as modified Rankin Scale scores of 4 to 6. The study was conducted between August 2002 and March 2004 in 73 hospitals and 20 countries. . . . [Full Text of this Article]

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				M. Hoffman and D. M. Monroe Tissue Factor in Brain Is Not Saturated With Factor VIIa: Implications for Factor VIIa Dosing in Intracerebral Hemorrhage Stroke, August 1, 2009; 40(8): 2882 - 2884. [Full Text] [PDF]