Intracerebral hemorrhage secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Secondary prevention

• Achieve & maintain greater BP reduction
  • Lifestyle modifications, and management of OSA and obesity are important
  • Improved support from health care providers & care takers
  • Patient education (involvement in BP monitoring are key to improve adherence to therapy)

**Receive early treatment targeted to an SBP level <140 mmHg to improve their chances of achieving better functional recovery if they survive the condition.

• Restarting anticoagulation should be avoided, UNLESS the risk of ischemic stroke is MUCH HIGHER than that of recurrent ICH
  • In AF patients with warfarin-associated lobar ICH or suspected CAA, the risk ICH recurrence seems higher than thromboembolic events. Therefore, the best management is to discontinue warfarin therapy.
  • In patients with lobar ICH and CHADS2 ≥5
    • LAA closure is a viable option
    • If LAA is not feasible oral anticoagulation (OAC) is considered
    • The use of DOACS (e.g. Apixaban) might be an alternative to warfarin
  • In warfarin-related ICH patients with prosthetic valves
    • The risk of thromboembolic events is higher than the risk of recurrent ICH (resumption of OAC with warfarin is often required)
  • The optimal time to resumption of anticoagulation after warfarin-related ICH is unclear and may vary from patient to patient
  • Avoidance of oral anticoagulation (OAC) for 4-8 weeks, in patients without mechanical heart valves, might decrease the risk of ICH recurrence

References

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