Deans' stroke musings: Hemostatic Therapies For Acute Spontaneous Intracerebral Hemorrhage

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, August 7, 2018

Hemostatic Therapies For Acute Spontaneous Intracerebral Hemorrhage

I didn't understand but hopefully your doctors have a protocol to account for this.
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022071?platform=hootsuite

Zhe Kang Law

Rustam Al-Shahi Salman

Philip M. Bath

Thorsten Steiner

and

Nikola Sprigg

Originally published5 Jul 2018Stroke. 2018;49:e271-e272

Outcome after spontaneous intracerebral hemorrhage (ICH) is worsened by hematoma growth, which occurs in up to one third of patients within 24 hours of onset. Early hemostatic therapy might improve outcome by limiting hematoma growth.

Objectives

This updated review aimed to examine the efficacy and safety of individual classes of hemostatic therapies in adults with acute spontaneous ICH, according to the type of antithrombotic drug taken immediately before ICH onset (ie, anticoagulant, antiplatelet, or none).¹

Methods

Search Methods

We searched the Cochrane Stroke Trials Register, MEDLINE, EMBASE, reference list of articles, and international trial registers up to November 2017.

Selection Criteria

We included randomized controlled trials (RCTs) of any hemostatic intervention for acute spontaneous ICH, compared with placebo, open control, or an active comparator, reporting relevant clinical outcomes.

Data Collection and Analysis

Two authors independently extracted data, assessed risk of bias, and contacted corresponding authors of eligible RCTs for specific data if they were not provided in the published report of an RCT.

Main Results

We included 12 RCTs involving 1732 participants. There were 7 RCTs of clotting factors versus placebo/control (1480 participants), 3 RCTs of antifibrinolytic drugs versus placebo/control (57 participants), 1 RCT of platelet transfusion versus control (190 participants) and 1 RCT of clotting factors versus fresh frozen plasma (5 participants). We could not include 2 eligible RCTs of clotting factors versus fresh frozen plasma because they presented aggregate data for ICH and other types of intracranial hemorrhage. In 1 RCT of platelet transfusion versus control for antiplatelet-related ICH, there was a significant increase in death or dependence (modified Rankin Scale score 4–6) at day 90 (70/97 versus 52/93; risk ratio 1.29; 95% confidence interval 1.04–1.61). There were no significant differences in death or dependency at day 90 for clotting factors versus placebo/control (risk ratio 0.87; 95% confidence interval 0.70–1.07; Figure) and antifibrinolytic drugs versus placebo/control (risk ratio 1.25; 95% confidence interval 0.57–2.75) for acute spontaneous ICH. There was no significant difference in death at day 90 for clotting factors versus fresh frozen plasma for anticoagulant-related ICH (risk ratio 0.27; 95% confidence interval 0.02–3.74).