Faculty Opinions recommendation of Hemostatic proteins and their association with hematoma growth in patients with acute intracerebral hemorrhage.

Introduction Microhemorrhages (MH) are lesions detected on radiological studies resulting from an underlying small-vessel angiopathy. We assesed the hypothesis that the presence of MH increases the risk of hematoma growth (HG) in patients with acute Intracerebral Hemorrhage (ICH). Methods We evaluated a series of patients in a prospective and multicentre study. We included patients with a spontaneous supratentorial ICH within the first 6 hours after symptom onset, that also had a follow-up CT 24-72 hours later and a MRI performed after a variable time after ICH. HG was defined as an increase >33% in the volume of hematoma on the follow-up CT, in comparison with the admission CT. The volume was calculated using the formula AxBxC/2. On MR scans we assessed the presence, number and distribution of MH. After differential diagnosis with other radiological lesions, MH were evaluated on echo-gradient sequences and defined as hypointense rounded lesions with a diameter <10mm. Statistical analysis: Bivariate tests with the whole sample and with the subgroup of patients with less than 3 hours from symptom onset. Results We studied 46 patients, whose mean age was 68.8±11.2 y and 68% were men. Mean baseline volume was 19.1±27.3 cc. We detected MH in 7/15 patients with HG and in 18/31 patients without HG (46.7% vs 58.1%, p=0.53). In the subgroup of patients with 10 MH, the risk of HG was higher than in patients with 0-10 MH (75% vs 28.6%, p=0.067), and this difference was significant when considering only patients with a <3 hours evolution (100% vs 31%, p=0.044). We did not observe any association between risk of HG and distribution of MH. Age and time to CT were equivalent in the two groups (with and without HG), either in the <6 or <3 hours subgroups. Conclusions In conclusion, in patients with hyperacute ICH, the presence of more than 10 MH increases the risk of HG. This is probably an indirect marker of a more severe underlying angiopathy.

Download Full-text

Earlier Blood Pressure-Lowering and Greater Attenuation of Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.112.651422 ◽

2012 ◽

Vol 43 (8) ◽

pp. 2236-2238 ◽

Cited By ~ 22

Author(s):

Hisatomi Arima ◽

Yining Huang ◽

Ji Guang Wang ◽

Emma Heeley ◽

Candice Delcourt ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Lowering ◽

Pressure Lowering ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage

Download Full-text

Abstract WP305: Impact of Potential Systolic Blood Pressure Treatment Thresholds on Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.awp305 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

David Rodriguez-Luna ◽

Marta Rubiera ◽

Marian Muchada ◽

Pilar Coscojuela ◽

Marc Ribo ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Statistical Significance ◽

Secondary Analysis ◽

Hematoma Enlargement ◽

Treatment Thresholds ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage ◽

The Impact

Background: Although the current AHA guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH), little is known about the relationships between different therapeutic target thresholds and hematoma growth (HG). Therefore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH. Methods: This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and noninvasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the percentage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as a relative enlargement greater than 33% or an absolute expansion more than 6 mL at 24 hours. Results: Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds, but not in the others (Figure). Whilst SBP load thresholds were correlated neither with baseline nor 24-hour ICH volumes, highest (170 to 200) but not lowest (140 to 160) SBP load thresholds were significantly correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05). In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001-1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010-1.097, p=0.016) were independently related to HG. Conclusions: In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guidelines recommendations is needed, at least below 170 mmHg, in order to minimize the deleterious effect of higher SBP on HG.

Download Full-text