Intracerebral hemorrhage: outcomes and eligibility for factor VIIa treatment in a National Stroke Registry.
BACKGROUND
Intracerebral hemorrhage (ICH) is a devastating form of stroke for which the lack of treatment options, high mortality rate, and the tendency to severely disable result in high social and economic burden.


METHODS
We analyzed data in the Registry of the Canadian Stroke Network (RCSN). We sought to: (1) provide a descriptive analysis of ICH; (2) determine the proportion of ICH patients that might have been eligible for treatment with recombinant activated factor VII (rFVIIa) using criteria from a recent phase II trial; (3) compare 6-month outcomes of ICH patients with those of ischemic stroke patients, matched for gender, age, and stroke severity.


RESULTS
In the RCSN, 11% of all strokes were nontraumatic ICH. The median Canadian Neurological Scale score was 7. A minority (33%) of patients arrived to the emergency department in less than 3 h from onset. In this cohort, in-hospital mortality was 15%. At 6 months, a further 9% of patients had died and 58% had a slight to no disability (Stroke Impact Scale-16 score > or = 75). Approximately 20% of ICH patients would have been eligible for rFVIIa treatment. Compared to ischemic stroke, ICH showed a trend towards increased mortality at discharge (OR: 1.96, CI: 0.99-3.87). At 6-month follow-up, ICH showed increased mortality (OR: 2.27, CI: 1.29-3.97), yet functional outcomes were not significantly different.


CONCLUSIONS
ICH patients had a higher case-fatality rate when compared to acute ischemic stroke, but survivors had similar functional outcomes. In Canada, about one fifth of ICH patients might potentially benefit from rFVIIa if it is approved, with the major exclusion factor being time.
Nadeau
Janel O
JO
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Phillips
Stephen
S
Shi
Haijiang S
HS
Kapral
Moira K
MK
Gladstone
David J
DJ
Silver
Frank L
FL
Hill
Michael D
MD
D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000534:rehabilitation; D002170:Canada; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000534:rehabilitation; D003029:Coagulants / Q000627:therapeutic use*; D015942:Factor VIIa / Q000235:genetics / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011994:Recombinant Proteins / Q000627:therapeutic use; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D000071939:Stroke Rehabilitation; D016019:Survival Analysis
D003029:Coagulants; D011994:Recombinant Proteins; D015942:Factor VIIa