•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.