Updated guidelines issued on management of spontaneous intracerebral hemorrhage

The American Heart Association and American Stroke Association recently issued updated guidelines on management of spontaneous intracerebral hemorrhage (ICH).

Outcomes of spontaneous cerebral hemorrhage can be greatly improved with timely, appropriate medical treatment. The AHA and ASA issued these guidelines in part to stress to clinicians the importance of their role and to provide "an evidence-based framework" for care. New recommendations or those revised from the 2007 guidelines include the following:

• Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively.Patients with ICH whose international normalized ratios are elevated due to oral anticoagulants should have warfarin withheld, receive therapy to replace vitamin K-dependent factors and correct the international normalized ratio, and receive intravenous vitamin K.
• Noting incomplete efficacy data pending ongoing trials, recommendations for the control of blood pressure continue to be made according to the systolic and diastolic blood pressure measurements as well as whether there is evidence of increased intracerebral pressure. Clinicians should consult the table provided in the guideline for guidance. In patients presenting with a systolic blood pressure of 150 to 220 mm Hg, acute lowering of systolic blood pressure to 140 mm Hg is probably safe.
• When stratifying a patient's risk of recurrent ICH may affect other management decisions, it is reasonable to consider the following risk factors: lobar location of the initial ICH, older age, ongoing anticoagulation, presence of the apolipoprotein E ε2 or ε4 alleles and greater number of microbleeds on MRI.After the acute ICH, in patients without medical contraindications, blood pressure should be well controlled, especially in those whose ICH location, such as the basal ganglia, thalamus, or brainstem, is typical of hypertensive vasculopathy.

The complete guidelines were published online July 22 by Stroke.