1st June 2007
American Heart Association
American Stroke Association
Summary, Abstract

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)

To present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage

TARGET POPULATION

Adults with spontaneous intracerebral hemorrhage

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

1. Computed tomography
2. Magnetic resonance imaging

Treatment

1. Initial medical therapy
   • Monitoring and management in intensive care unit
   • Antiepileptic therapy
   • Antipyretic therapy
   • Early mobilization and rehabilitation for patients with ischemic stroke (as indicated)
   • Treatment of elevated intracranial pressure
   • Treatment of hyperglycemia (insulin)
   • Management of blood pressure
   • Recombinant activated factor VII (rFVIIa) (as part of a clinical trial only)
2. Prevention of deep vein thrombosis and pulmonary embolism
   • Pneumatic compression therapy
   • Treatment of hypertension
   • Heparin - low molecular weight, unfractionated
   • Vena cava filter
   • Long-term antithrombotic therapy
3. Management of coagulation and fibrinolysis
   • Protamine sulfate
   • Intravenous vitamin K
   • Prothrombin complex concentrate, factor IX complex concentrate, rFVIIa
   • Restarting antithrombotic therapy after antithrombotic therapy-related intracerebral hemorrhage (ICH)
   • Treatment of antithrombolytic therapy-related ICH
4. Surgical treatment of ICH/intraventricular hemorrhage
   • Craniotomy
   • Timing of craniotomy
5. Withdrawal of technological support
6. Prevention of recurrent ICH
   • Treatment of hypertension
   • Modification of lifestyle risks: smoking, alcohol use, cocaine use

MAJOR OUTCOMES CONSIDERED

• Neurologic deterioration
• Morbidity, including deep vein thrombosis, pulmonary embolism, rebleeding
• Functional outcome
• Mortality
• Adverse events associated with therapy