Early haemostatic therapy for spontaneous intracranial haemorrhage

Intracranial haemorrhage (ICH) accounts for approximately 10%-15% of all strokes and is associated with the highest mortality rate and with the highest degree of disability among the survivors compared to all other strokes. The role of surgical and medical treatment is controversial. Recently, a parallel-group trial design between early surgery versus initial conservative treatment in patients with ICH showed no overall benefit from surgery. Several agents could theoretically be used. Activated recombinant factor VII administered within 4 hours after the onset of ICH seems to be the best candidate: in a recent study, it limited the growth of the haematoma, reduced mortality and improved functional outcome at 90 days. Further studies are necessary to define optimal dose of this drug, verify its efficacy and identify patients at high risk for thromboembolic complications.