Intracerebral hemorrhage secondary prevention: Difference between revisions
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====Restarting anticoagulation==== | ====Restarting anticoagulation==== | ||
Restarting anticoagulation should be avoided, UNLESS the risk of [[ischemic stroke]] is MUCH HIGHER than that of recurrent ICH. | Restarting anticoagulation should be avoided, UNLESS the risk of [[ischemic stroke]] is MUCH HIGHER than that of recurrent ICH.<ref name=DOACs>Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review http://dx.doi.org/10.1016/j.thromres.2015.05.001 Accessed on December 1, 2016</ref> | ||
* In AF patients with warfarin-associated lobar ICH or suspected [[Cerebral amyloid angiopathy|CAA]], the risk ICH recurrence seems higher than [[Thromboembolic event|thromboembolic events]]. Therefore, the best management is to discontinue [[Warfarin|warfarin therapy.]] | * In AF patients with warfarin-associated lobar ICH or suspected [[Cerebral amyloid angiopathy|CAA]], the risk ICH recurrence seems higher than [[Thromboembolic event|thromboembolic events]]. Therefore, the best management is to discontinue [[Warfarin|warfarin therapy.]] | ||
**In patients with lobar ICH and [[CHA2DS2-VASc Score|CHADS2 VASc score]] > 5 | |||
*In patients with lobar ICH and [[CHA2DS2-VASc Score|CHADS2 VASc score]] > 5 | *** [[Left atrial appendage|LAA closure]] is a viable option | ||
** [[Left atrial appendage|LAA closure]] is a viable option | ***If [[Left atrial appendage|LAA]] is not feasible [[Oral anticoagulation therapy|oral anticoagulation (OAC)]] is considered | ||
**If [[Left atrial appendage|LAA]] is not feasible [[Oral anticoagulation therapy|oral anticoagulation (OAC)]] is considered | ***The use of DOACS (e.g. [[Apixaban]]) might be an alternative to [[warfarin]] | ||
**The use of DOACS (e.g. [[Apixaban]]) might be an alternative to [[warfarin]] | |||
*In warfarin-related ICH patients with [[prosthetic valves]] | *In warfarin-related ICH patients with [[prosthetic valves]] | ||
**The risk of [[Thromboembolic event|thromboembolic events]] is higher than the risk of recurrent ICH (resumption of [[Oral anticoagulation therapy|OAC]] with [[warfarin]] is often required) | **The risk of [[Thromboembolic event|thromboembolic events]] is higher than the risk of recurrent ICH (resumption of [[Oral anticoagulation therapy|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 | *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 | *Avoidance of oral anticoagulation (OAC) for 4-8 weeks, in patients without mechanical heart valves, might decrease the risk of ICH recurrence | ||
===Prevention of complications=== | ===Prevention of complications=== | ||
The preventive measures which may help prevent complications of intracerebral hemorrhage include:<ref name="pmid20539816" /> | The preventive measures which may help prevent complications of intracerebral hemorrhage include:<ref name="pmid20539816" /> | ||
Revision as of 16:28, 1 December 2016
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Intracerebral hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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Case Studies |
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Intracerebral hemorrhage secondary prevention On the Web |
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American Roentgen Ray Society Images of Intracerebral hemorrhage secondary prevention |
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Risk calculators and risk factors for Intracerebral hemorrhage secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Secondary prevention
Life style modification
Life style modification measures which may help reduce the risk of intracerebral hemorrhage recurrent may include:
- Eating healthy balanced diet
- Smoking cessation
- Decreased alcohal intake
- Improved support from health care providers & care takers
- Patient education (involvement in BP monitoring to improve adherence to therapy)
Prevention of recurrent ICH
Blood pressure control
Receive early treatment targeted to an SBP level <140 mmHg to improve the chances of achieving better functional recovery
Restarting anticoagulation
Restarting anticoagulation should be avoided, UNLESS the risk of ischemic stroke is MUCH HIGHER than that of recurrent ICH.[1]
- 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 VASc score > 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 patients with lobar ICH and CHADS2 VASc score > 5
- 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
Prevention of complications
The preventive measures which may help prevent complications of intracerebral hemorrhage include:[2]
- Use of intermittent pneumatic compression begun as early as the day of hospital admission
- Prophylactic anticonvulsant medication has not been demonstrated to be beneficia. However, in a case of clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antisezure drugs to prevent recurrence
- Proper positioning of patient, and the use of thick feed with the help of nasogastric tube for feeding to prevent aspiration pneumonia in patients with cranial nerve palsies affecting pharyngeal motility and gag reflex
- Pressure ulcers may be prevented by use of air mattress and regular change in position of patient
References
- ↑ Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review http://dx.doi.org/10.1016/j.thromres.2015.05.001 Accessed on December 1, 2016
- ↑