Rapid administration of antifibrinolytics and strict blood pressure control for intracerebral hemorrhage.
OBJECTIVE
Hematoma growth is a major cause of poor outcome in patients with intracerebral hemorrhage. We evaluated the efficacy of a combination of rapid antifibrinolytic therapy and strict blood pressure control for prevention of hematoma growth in this retrospective study.


METHODS
Systolic blood pressure was strictly controlled below 150 mm Hg by use of intravenously administered nicardipine (BPC). Prolonged infusion of antifibrinolytic therapy was given by intravenous administration of 1 g tranexamic acid over a period of 6 hours (PAF). Rapid administration of antifibrinolytic therapy was given by intravenous administration of 2 g tranexamic acid over a period of 10 minutes (RAF). Immediately after diagnosis of intracerebral hemorrhage on computed tomographic scan, 156 patients who were admitted within 24 hours of onset were treated with either a combination of PAF and BPC (PAF group) or a combination of RAF and BPC (RAF group). The incidence of hematoma growth determined by a second computed tomographic scan the day after admission was compared between the PAF and the RAF groups.


RESULTS
Hematoma growth was observed in 11 (17.5%) of 63 patients in the PAF group and 4 (4.3%) of 93 patients in the RAF group using a 20% cutoff value for hematoma enlargement. The RAF group showed a significantly low incidence of hematoma growth compared with the PAF group (P < 0.05). Between the two groups, there was no significant difference in any of the other factors reported to affect hematoma growth.


CONCLUSIONS
The combination of rapid administration of antifibrinolytics and strict blood pressure control may prevent hematoma growth in patients with intracerebral hemorrhage.
Sorimachi
Takatoshi
T
Department of Neurosurgery, Nishiogi-chuo Hospital, Tokyo, Japan. sorimachi-t@h2.dion.ne.jp
Fujii
Yukihiko
Y
Morita
Kenichi
K
Tanaka
Ryuichi
R
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D014665:Vasodilator Agents; D014148:Tranexamic Acid; D009529:Nicardipine