ICH

Question 1

Medical vs. Surgical Management

Answer 1

• STICH Trial (2005): Early surgery in patients with spontaneous supratentorial intracerebral haematomas did not show a significant survival advantage as compared to initial conservative treatment.
• STICH II (2013): Early surgery did not increase the rate of death or disability at 6 months and showed a trend towards improved outcome, so it is as good an option as conservative treatment for superficial lobar intracerebral hemorrhage.

Question 2

Blood Pressure Management

Answer 2

• INTERACT2 (2013): Intensive lowering of blood pressure in patients with acute intracerebral hemorrhage did not result in a significant reduction in the rate of death or severe disability, but led to improved functional outcomes.
• ATACH-2 Trial (2016): Intensive blood pressure reduction did not reduce the rate of death or disability, although it resulted in significantly lower rates of hematoma expansion.

Question 3

Hematoma Expansion

Answer 3

• STOP-IT (2018): Rapid administration of antifibrinolytic therapy to patients with intracerebral hemorrhage did not reduce hematoma expansion compared with placebo.

Question 4

Anticoagulation Reversal

Answer 4

• REVERSE-AD (2016): Found that Idarucizumab, a monoclonal antibody fragment, rapidly reversed the anticoagulant effect of Dabigatran in patients with uncontrolled bleeding or who required an urgent procedure.
• ANNEXA-4 (2019): Showed that Andexanet Alfa rapidly reversed the anticoagulant effects of Factor Xa inhibitors in acutely bleeding patients.