Hatim Attar, MD
There are various strategies to tackle acute Intracerebral Hemorrhage (ICH) with intent to minimize the risk of hematoma expansion and preserve brain perfusion. These have been areas of interest for decades with ongoing research and regular updates in management. In today’s Neuro-Intensive care units, one increasingly encounters patients who are on various antiplatelet (AP) and anticoagulant (AC) agents. These agents, without a doubt, are implicated with spontaneous ICH and subsequent hematoma expansion, too. This review has addressed the burning question: Which hemostatic therapies should be used in spontaneous ICH in the setting of antithrombotic agents?
The authors searched multiple databases and reviewed all available international trials until November 2017. They included randomized controlled trials (RCTs) which evaluated any hemostatic intervention for acute spontaneous ICH. A total of 12 RCTs were found relevant and included in this review, which amounted to a total of 1732 participants. 7 RCTs, involving 1480 participants, were on administration of clotting factors, 3 RCTs with 57 participants on antifibrinolytic drugs, 1 RCT with 190 participants on platelet transfusion, and another 1 RCT with 5 participants on clotting factors vs. fresh frozen plasma. RCTs which used aggregated data for ICH, not differentiating spontaneous hemorrhages from others, were excluded.