• HTN Emergency- Elevated BP with evidence of acute end-organ dysfunction
      CNS- stroke – if n/v present indication for head CT?
      Renal- AKI
      CV- ischemic chest pain or acute heart failure
      Optho-Look for flame shaped hemorrhages; also can look at fundus for   signs of increased intracranial pressure
  
  BP Lowering:
    Lower by ~25% initially
    Systolic/Diastolic target over 2-6 hrs. ~160mmHg/110mmHg respectively
  
  

  Posted 02/07/17 10:17:54 AM by Adam Faye

• Does platelet transfusion improve outcomes in patients with spontaneous ICH?
  THE BOTTOM LINE None of these studies showed a mortality benefit or improved functional outcome with platelet transfusion in patients with spontaneous or traumatic intracerebral hemorrhage who were receiving antiplatelet medications 
  
  Plt. transfusion vs. standard care after acute stroke 2/2 ICH
  Multicenter study: Adults within 6hr of ICH if used anti-plt for at least 7 days beforehand.
  •Plts within 90min of imaging results
  •41 sites, 190 pts
  •Overall mortality odds higher if received plt (2.05) 
  
  

  Posted 02/07/17 10:25:08 AM by Adam Faye

• BP goal after ICH:
  
  Interact Trial - Suggested 140mmHg better than 180mmHg since hematoma growth was lower:
  Acute ICH within 6hr + SBP (150-220 mmHg):
  •Randomized to early intensive BP control: 140mmHg vs. 180mmHg
  •Mean hematoma growth was 36.3% in lenient BP group vs. 13.7% in the intensive group at 24h. (Absolute volume diff. 1.7ml)
  •No improvement in adverse events or clinical outcomes at 90 days
  
  ATACH-2 trial: - Suggested that lower than 140mmHg did not have any improved outcomes and in fact had more adverse events
  1,000 pts. SBP 110-139mmHg vs. 140-179mmHg (nicardipine drip)
  •Primary Endpoint- Death or disability at 3 months 
  •38.7% in intensive BP goal group vs. 37.7% in the standard-treatment group
  •Adverse events 1.6% in intensive therapy group vs. 1.2% in standard treatment group 
  
  
  
  

  Posted 02/07/17 10:28:04 AM by Adam Faye

• DVT PPx after ICH:
  
  ICH patients in general may benefit from starting prophylactic-dose heparin therapy early. 
  One randomized trial found that starting heparin in a low subcutaneous dose the day after an ICH decreased the risk of thromboembolism without increasing the risk of rebleeding. Another study also found no increased risk of rebleeding with early prophylactic-dose subcutaneous heparin.
  As the benefit appears to outweigh the risk, national guidelines suggest starting sub-cutaneous heparin early in all ICH patients, including those not previously on warfarin.
  
  

  Posted 02/07/17 10:28:49 AM by Adam Faye

Created by Christopher Kelly

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