Hematoma Expansion in ICH: Targeting Epidemiology or Biology?

Excerpt

Hematomas expand, and this is often bad for our patients. In fact, hematoma expansion is probably the rule and not the exception, even in patients without coagulopathy. While it is often stated that hematoma expansion occurs 38% of the time, this derives from a seminal publication over two decades ago in which the threshold of 33% enlargement over baseline was used to define hematoma expansion [1]. However, when the placebo group from the phase II factor VIIa study was assessed, any hematoma expansion occurred in 73% of patients. It may be that all patients experience some degree of hematoma expansion if considered from the initial bleeding ictus, even if this expansion occurs prior to initial in-hospital neuroimaging. Intracerebral hemorrhage (ICH) is a dynamic disease, and prevention of hematoma expansion is a compelling target. Unfortunately, finding a treatment that lessens hematoma expansion and improves patient outcome has been elusive [2]. Triangulating between patient selection, a biologically highly active intervention, and an outcome measure that detects meaningful effects seems mandatory. …