Intracerebral hemorrhage secondary prevention
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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 are key to improve adherence to therapy)
Secondary prevention of recurrence
Treatment and maintainence of hypertension
- 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
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
Secondary prevention of complications
The preventive measures which may help prevent complications of hemorrhagic stroke include:[1]
- 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